Perineal rectosigmoidectomy – Altemeier procedure

After completely exposing the external prolapse attach the Lone Star retractor and expose the dentate line. Then a circular incision of the outer duplication of the rectal wall 1-2 cm above the dentate line is made under gentle traction at the tip of the prolapse with Allis clamps, so that the anastomosis is later proximal to the puborectal muscle.

Step by step, transect the rectal wall with bipolar scissors. At each exposed part of this incision, grasp the caudal rectal wall and place Gambee sutures without tying them.
Note: Make the first full-thickness stitch of the absorbable multifilament suture from the submucosa to the inside and the return stitch from the inside to the outside. Put tension on the ends of the suture to open up the anal ring in circular fashion.

The herniated Douglas pouch presents on the anterior circumference of the inner intestinal loop, is opened and at the same time armored with sutures of a different color. Under digital control, transect the lateral ligaments with their pathways between ligatures.

Finish dissection of the thickened elongated mesorectum/mesosigmoid, which is then transected between ligatures at the level of the superior resection margin.