A 70-year-old woman presents with complete rectal prolapse (full-thickness) and severe faecal incontinence. She is medically fit for surgery. Which perineal procedure is most appropriate given her age and incontinence?

• A Laparoscopic ventral mesh rectopexy
• B Ripstein procedure (anterior sling rectopexy)
• C Altemeier procedure (perineal proctosigmoidectomy) with levatoroplasty ✓
• D Delorme procedure (mucosal sleeve resection)

Explanation

The Altemeier procedure is the perineal approach of choice for elderly or high-risk patients with full-thickness rectal prolapse. It involves perineal proctosigmoidectomy with levatoroplasty and avoids the physiological stress of abdominal surgery. The Delorme procedure is reserved for short-segment prolapse (under 3 to 4 cm). Ventral mesh rectopexy and Ripstein are abdominal procedures preferred for younger, fitter patients, though the Altemeier is preferred in the elderly.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.