Altemeier Perineal Proctosigmoidectomy for Rectal Prolapse

1. Introduction

2. Patient Preparation

1. Patient Positioning
2. Preoperative Exam and Delivery of Prolapse
3. Exposure with Retractor
4. Examine Anatomy and Score Dissection Line Around Rectum
5. Inject Local Anesthetic Along Score Line for Hemostasis

3. Full-Thickness Rectal Dissection to the Mesentery on the Inside

4. Evert Rectum to See Entire Rectal Edge

1. Make Windows into Mesentery and Divide with LigaSure to Deliver More Rectum

5. Open Pouch of Douglas to Enter Abdominal Cavity

6. Inspect Sigmoid Colon and Determine Level of Resection

7. Posterior Levatorplasty

8. Close Pouch of Douglas

9. Transection

10. Complete Anastomosis

11. Inject Marcaine for Pudendal Nerve Block

12. Examination of Specimen

13. Post-op Remarks