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II Altemeier Altemeier's procedure for rectal prolapse Altemeier s procedure for prolapse has been employed for more than 100 years. The operation consists essentially of perineal rectosigmoidectomy and levator plasty. It can be performed under a general, saddle block or even local anesthesia. Therefore, the operation is generally recognized as one of the procedures of choice for elderly debilitated patients who can tolerate the procedure well. In the past the procedure was limited to this category of patient because of the high recurrence rates reported. However, a recent detailed clinical assessment indicates excellent results including a low rate of recurrence, morbidity and improvement of bowel dysfunctions such as incontinence. Therefore, the detailed procedure should be tailored to the pathology of the individual. There are three major theories of the pathology: circumferential intussusceptions, sliding hernia and attribute to mucosal prolapse. Moreover, various other factors are concomitant with the condition, and often need to be balanced against one another. Of course, Altemeier s procedure itself may not be able to solve all the problems. However, as the procedure is so simple, we can modify it to suit the pathology. Altemeier s procedure comes closest to achieving the goals regardless of patient age and associated co-morbidities, providing excellent results and resolving problems in defecation.

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