Elective versus emergency full thickness rectal prolapse treatment using a perineal approach - a video vignette

Altemeier's procedure is a well-known operation that can be performed under spinal anaesthesia, avoiding the trauma of a laparotomy, reducing the surgical stress and allowing a rapid recovery of patients[1]. Usually patients with full-thickness rectal prolapse are investigated before the elective surgery and undergo preoperative assessment starting with a clinical examination and then further investigations including pelvic MRI, dynamic defecography and anorectal manometry[2]. All contribute to the decision to carry out a safe and "standard" perineal rectosigmoidectomy. However, these cannot be performed as an emergency if the prolapse becomes strangulated or incarcerated [3]. Although the Altemeier's procedure has been demonstrated to be useful and effective in the emergency situation, the key steps of the technique need to be modified according to this different clinical scenario [4, 5]. In this video we demonstrate the perineal recto-sigmoidectomy in the elective and an emergency situation and highlight the main differences in surgical technique.