QS213 - Recurrence Rates and Risk Factors Following Altemeier Procedure for Rectal Prolapse: A Multicenter Study

Monday, June 3, 2024

2:06 PM – 2:09 PM ET, USA

Location: Room 327

Quick Shot Presenter(s)

Lukas Schabl, MD

Researcher
Cleveland Clinic, Cleveland Ohio
Cleveland Clinic, Ohio, USA
Cleveland, OH, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no relevant relationships with ineligible companies.

Author(s)

Tracy L. Hull, MD

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland Clinic Foundation, Lerner School of Medicine of Case Western University
Chagrin Falls, Ohio, United States

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This individual has no financial relationships with ineligible companies.
RG

Rebecca Gunter, MD

Staff Surgeon
Hillcrest Hospital, Departement Colorectal Surgery, Cleveland Clinic, Cleveland Ohio
Cleveland, Ohio, United States

Disclosure information not submitted.
Kristen A. Ban, MD

Colorectal Surgeon
Cleveland Clinic Foundation
C;leveland, Ohio, United States

Disclosure information not submitted.
Scott Steele, MD MBA

President, Chairman, Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Anna R. Spivak, DO (she/her/hers)

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland Clinic Foundation
Cleveland, Ohio, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Purpose/Background: Perineal proctosigmoidectomy remains a commonly performed surgical intervention for rectal prolapse. Reported prolapse recurrence rates following Altemeier procedure repair vary widely across the literature. This study aims to report the rates of first and subsequent recurrences in patients who underwent perineal proctosigmoidectomy. It also identifies potential risk factors for recurrence, comparing them with existing literature, and examines treatment options for recurrences.

Methods/Interventions: The digital medical records from six hospitals affiliated with our unit, spanning the years 1997 to 2021, were searched. We identified patients who had undergone perineal proctosigmoidectomy for rectal prolapse. We collected previously reported factors that might influence recurrence risk and compared these findings with the existing literature.

Results/Outcomes: Among 184 patients identified, 95% were female, the median age was 80 (range 27-100), and 93% underwent a non-emergent surgery. 16% had previously undergone surgeries for rectal prolapse before their initial perineal proctosigmoidectomy, including a Delorme (10%), Thiersch (1%), abdominal suture rectopexy (3%), abdominal mesh rectopexy (1%), and abdominal resection rectopexy (1%). Over a mean follow-up period of 27.3 months (SD 45.5), 39.9% of patients experienced a recurrence, and 16% of patients had at least two recurrences. A subsequent Altemeier procedure was performed in 72% of the cases of recurrence. Other treatments performed were Delorme (1%), abdominal suture rectopexy (10%), abdominal mesh rectopexy (3%), or conservative management (13%). Our study identified the presence of a connective tissue disorder and time since surgery as significant risk factors for recurrence.

Conclusion/Discussion: Perineal proctosigmoidectomy is associated with a significant risk of recurrence, which should be comprehensively discussed with patients considering the surgery. Our analysis suggest that the risk of recurrence is positively correlated with the presence of a connective tissue disorder. The recurrence rate increased in correlation with the time since surgery. These insights can guide clinicians in counseling and managing patients undergoing perineal proctosigmoidectomy for rectal prolapse.