.gov All rights reserved. Before At follow-up any change in pelvic floor function and recurrences were determined. Unable to load your collection due to an error, Unable to load your delegates due to an error. Color Dis. We made the GEMs files available for FY 2016, FY 2017 and FY 2018. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 1984;7(6):37681. Recurrence over time(Kaplan-Meier curve). Epub 2021 Oct 21. Cochrane Database Syst Rev. All patients had a coloanal hand sewn anastomosis and in 25 (58%) a levatorplasty was also performed. [?mgf|uH The final step of the Altemeier Perineal Rectosigmoidectomy revolves around the anastomosis of the sigmoid with the anal ring where all of the different sutures are tied together. 1992;35(9):8304. The Altemeier procedure for rectal prolapse: an operation for all ages. 2019 Nov;23(11):1065-1072. doi: 10.1007/s10151-019-02100-z. There was a statistically significant decrease postoperatively in the median of the differences of 2.5 (p<0.001) (Fig. 2004;8(1):39. or The 2021 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2021. Does anyone out there know if the procedure code 45130, altemeier procedure for rectal prolapse when done with posterior levatorplasty includes the levatorplasty procedure? This would be coded as an open approach since the laceration has cut through the external body layers exposing the muscle. Rectal prolapse surgery requires anesthesia. 2014;16(11):9204. Note: There is no GEMs file. BMC Surg 19, 1 (2019). Percutaneous endoscopic-assisted procedures are coded to the open approach as stated above. This site complies with the HONcode standard for trustworthy health information: verify here. Impact of new technologies on the clinical and functional outcome of Altemeier's procedure: a randomized, controlled trial. BMC Surgery Does this make perineal procedures obsolete? This site needs JavaScript to work properly. The thickened, elongated mesorectum/mesosigmoid dissection takes place now. Gastroenterol Clin Biol. Disclaimer. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Results: It is important to note that rectal prolapse does not always occur with symptoms. Epub 2019 Feb 4. In Table 4 are summarized the literature data on recurrences after Altemeiers procedure [10,11,12,13,14,15,16,17,18, 24,25,26,27,28,29,30]. Altemeiers procedure for rectal prolapse: analysis of long-term outcome in 60 patients. PubMed who found that the removal of a shorter specimen was followed by a higher risk of relapse [14, 17]. 2012;14(9):110611. Altemeier WA, Culbertson WR, Schowengerdt C, et al. or Federal government websites often end in .gov or .mil. The 45505 code is for a proctoplasty for prolapse of mucous membrane. These guidelines should be used as a companion document to the official version of the ICD-10-PCS as published on the CMS website. 2019 Aug;7(4):279-282. doi: 10.1093/gastro/goz016. Or is there a seperate code for the levatorplasty code that I can bill in addition to the 45130 code. These 2020 ICD-10-PCS codes are to be used for discharges occurring from October 1, 2019 through September 30, 2020. This site needs JavaScript to work properly. External rectal prolapse: abdominal or perineal repair for men? According to many researchers, there are between three and five ways in which the rectal prolapse can occur. Fortunately, there is a procedure that can correct the condition. The ICD-10-PCS is a procedure classification published by the United States for 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-PCS) The files in the Downloads section below contain information on the ICD-10-PCS COVID-19 updates effective with discharges on and after August 1, 2020. Of these 30, 14 had had a previous surgical repair for rectal prolapse by various techniques (4 Delorme, 2 STARR, 1 transanal proctopexy, 1 rectosigmoidectomy + anal encirclement, 1 rectopexy, 1 rectopexy with mesh, 1 Wells procedure, 3 no data), 24 had had a hysterectomy and seven had had a cystopexy. Before endobj (XLSX 20 kb). However, high recurrence rates relegated it to a back-up role for elderly or other high-risk patients who were not candidates for an abdominal operation. Defined as entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure, and entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure. One example is an LAVH or laparoscopic assisted vaginal hysterectomy. website belongs to an official government organization in the United States. 2007. Your doctor is likely to recommend drinking lots of fluids, using stool softeners, and eating a fiber-rich diet in the weeks after surgery to avoid constipation and excessive straining that can lead to recurrence of the rectal prolapse. When clients can depend on quality services delivered the right way, they find success, and thats how we measure our own. The 2021 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2021. This also requires the exposure of the sling of the levator ani. Ding JH, Canedo J, Lee SH, et al. The 2020 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2020. The procedure is known as the Altemeier perineal rectosigmoidectomy. Young MT, Jafari MD, Phelan MJ, et al. The probability of recurrence at 48months was determined using the Kaplan-Meier method. website belongs to an official government organization in the United States. Accessed March 22, 2021. Dis Colon Rectum. This category only includes cookies that ensures basic functionalities and security features of the website. Continence was assessed pre and post-operatively using the Vaizey scoring system [6], which ranges from 0 (normal continence) to 24 (severe incontinence). ARL, RT, GG and EN gave substantial contribution to the acquisition, analysis and interpretation of data. lock A laparoscopic approach to rectal prolapse repair has become increasingly popular. Many comparisons of the perineal and abdominal approaches have pointed to worsening or the de novo appearance of obstructed defecation in the case of the latter [19]. Female gender with possible obstetric trauma, the wider pelvis and weaker pelvic floor due to age and gender are factors that would contribute to poor function and the failure of repair of the prolapse to alter most of the functional scores indicates that the prolapse itself may not be an important factor in the bowel and urinary dysfunction often observed in patients with prolapse. An announcement was also made at the September 2017 ICD-10 Coordination and Maintenance Committee meeting that FY 2018 would be the last GEMs file update. endobj Perineal rectosigmoidectomy (Altemeier's procedure), as used for the surgical treatment of full-thickness rectal prolapse, has a long history. There was no post-operative mortality at 30days. The present study evaluated the morbidity, mortality, function and recurrence rate in patients undergoing Altemeiers operation for complete rectal prolapse. is cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. The average duration of symptoms was 2years. Advances in preoperative risk assessment and management. Color Dis. 2012;55(6):66670. In response to the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services (CMS) is implementing 21 new procedure codes to describe the introduction or infusion of therapeutics into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), effective January 1, 2021. These 2020 ICD-10-PCS codes are to be used for discharges occurring from October 1, 2019 through September 30, 2020. An official website of the United States government. Please enable it to take advantage of the complete set of features! Statistical analysis was conducted using SPSS software (SPSS, Chicago, Illinois, USA) and MedCalc Statistical Software (MedCalc Software, Ostend, Belgium). Surgery. Kimmins MH, Evetts BK, Isler J, et al. Analysis of possible factors related to recurrence showed no statistical relationship to age, gender, BMI, ASA score, recurrent prolapse already repaired, previous hysterectomy, the length of resected bowel or the addition of a levatorplasty to the repair. FOIA Article See: Altemeier operation . 2020 Apr 13;54:22-25. doi: 10.1016/j.amsu.2020.03.011. who reported a statistically significant association of revision Altemeier procedure with recurrence or to the report of Kim et al. Carditello A, Milone A, Stilo F, Mollo F, Basile M. Zentralbl Chir. The procedure is known as the Altemeier perineal rectosigmoidectomy. So, it could be an available option for frail patients with complete rectal prolapse. Secure .gov websites use HTTPSA 2006;30:65963. %PDF-1.5 Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Ramanujam PS, Venkatesh KS, Fietz MJ. Elagili F, Gurland B, Liu X, et al. Curr Probl Surg. <> 2012;59(2):214. 2011;25(8):2699702. Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era? It was retrospective and the follow up was not performed in all patients. Alwahid M, Knight SR, Wadhawan H, Campbell KL, Ziyaie D, Koch SMP. The Authors thank Miss Simona Graziani, head nurse of the Department of Colorectal Surgery at the Clinica Santa Rita, Vercelli, for her essential role in the preparation of this manuscript. Advertising revenue supports our not-for-profit mission. A small nick in the skin or small incision made in the skin does not constitute an open approach. It offered improved evacuation in constipated patients while didnt improve fecal and urinary continence. As previously suggested, patients with complete rectal prolapse should be preoperatively assessed holistically with a record made of fecal incontinence, constipation, dysuria or urinary retention and urinary incontinence [8]. Day case robotic ventral rectopexy compared with day case laparoscopic ventral rectopexy: a prospective study. In contrast the perineal approach which reduces rectal capacity and rectal wall compliance may increase the frequency of defecation, urgency and fecal incontinence in up to 40% of patients [21] with constipation reported in 10% [22]. A single copy of these materials may be reprinted for noncommercial personal use only. Although anyone of any age could suffer from this condition, it is more common in elderly women. 2012 Sep;14(9):1106-11. doi: 10.1111/j.1463-1318.2011.02904.x. 2015;19(9):5215. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 15 0 R] /MediaBox[ 0 0 595 842] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Scand J Surg. At long-term follow-up functional results demonstrate a statistically significant decrease in the Obstructive Defecation Syndrome (ODS) score, but no statistically significant changes in the Vaizey score, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) score and the urinary retention score. Surgical Procedures on the Colon and Rectum. 2005 Jan;140(1):63-73. doi: 10.1001/archsurg.140.1.63. is entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and/or any other body layers necessary to reach the site of the procedure. x\r6}wT RL&Z8kWa&2EKR[dbY$H6NN7@_]U>"X~~vcgfsvF?t~wyFsx2gcaase{Aqj# /B[J-$k{~8>Tz@?0NA}#tyA-\!%(B In contrast to the many observational studies, the PROSPER randomized study, the largest on rectal prolapse, compared the recurrence rate, incontinence, bowel function and quality of life (QoL) of perineal and abdominal procedures and showed an improvement in symptom-specific and overall QoL for both types of procedure with a similar incidence of recurrence (28% vs 19%; p=0.2) and no significant difference in bowel function and QoL [15]. Rev Gastroenterol Mex. 2020 Jul 30;4(3):89-99. doi: 10.23922/jarc.2019-035. Surg Endosc. A p-value of <0.05 was considered to be statistically significant. Rev Saude Publica. 3 0 obj Rectal prolapse repair through the area around the anus (perineal rectosigmoidectomy). Recurrence of prolapse was 40% at four years. <> Percutaneous approach is entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and/or any other body layers necessary to reach the site of the procedure. Only two patients who presented with rectal prolapse recurrence underwent a reoperation, one redo-Altemeiers procedure and one Goldbergs procedure. Perineal Rectosigmoidectomy (Altemeier Procedure) None. You also have the option to opt-out of these cookies. Laparoscopic-assisted perineal rectosigmoidectomy for rectal prolapse. The incision location is at the tip of the prolapse with the aid of Allis clamps under gentle traction. 2 0 obj 2012;55:6605. (Wilcoxon signed rank test). Altemeiers procedure is one of the well-known perineal operations to treat full-thickness rectal prolapse; it removes the prolapse without a pexy and performs only a partial reconstruction of the pouch of Douglas. General anesthesia was used in 18 (42%) patients and a spinal block in 25 (58%). The .gov means its official. Thereby it offers the advantages of minimal surgical stress and low post-operative morbidity and mortality. This website uses cookies to improve your experience while you navigate through the website. It is indicated in symptomatic patients with an external . government site. Conclusions: To this point, there has been no evidence of recurrence in this group of patients, pending longer periods of follow-up, especially among patients from the younger age groups. The relationship between changes in the ODS score and Vaizey score in respect to levatorplasty was evaluated using the unpaired t-test and the Mann-Whitney U-test. Altemeiers procedure for complete rectal prolapse; outcome and function in 43 consecutive female patients, https://doi.org/10.1186/s12893-018-0463-7, https://doi.org/10.1002/14651858.CD001758.pub3, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. is for procedures performed directly on the skin or mucous membrane and procedures performed indirectly by the application of external force through the skin or mucous membrane. Part of The suture line receives inspection with a speculum and an easy-flow drain goes in the anal canal. The rectum makes up the last several inches of the colon. Clinical practice guidelines for the treatment of rectal prolapse. The relationship between recurrence and age, BMI, previous rectal prolapse surgery, previous hysterectomy, levatorplasty, length of resected bowel and gender was evaluated using an independent-sample t-test, Pearsons chi-squared test or Fishers exact test. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, ICD-10-CM and ICD-10 PCS and GEMs Archive, ICD-10 Coordination and Maintenance Committee Meetings, Process for Requesting New/Revised ICD-10-PCS Procedure Codes, ICD-10 Coordination and Maintenance Committee Meeting Materials, ICD-9-CM Diagnosis and Procedure Codes: Abbreviated and Full Code Titles, Updates and Revisions to ICD-9-CM Procedure Codes (Addendum), 2020 COVID-19 UPDATE FILES EFFECTIVE AUGUST 1, 2020 (ZIP), 2020 Official ICD-10-PCS Coding Guidelines (Updated 6/13/19) (PDF), 2020 ICD-10-PCS Code Tables and Index (Updated 08/14/19) (ZIP), 2020 ICD-10-PCS Order File (Long and Abbreviated Titles) (ZIP). HIA offers PRN support as well as, Reporting Intra-Aortic Balloon Pump (IABP) in ICD-10-PCS 5A02210, Find Your Routine: Increase Reading Speed to Maximize Productivity. In contrast our data were similar to those of Ris et al. 2018 Dec;22(12):919-931. doi: 10.1007/s10151-018-1908-9. SEER Program Coding and Staging Manual 2021 Appendix C: Surgery Codes 1 . Thanks S sscott@hogonc.com Networker ) Three patients experienced a worsening and in ten there was no change. Surgery for complete (full-thickness) rectal prolapse in adults. 2023 ICD-10-PCS Procedure Code 08Q23ZZ; 2023 ICD-10-PCS Procedure Code 08Q23ZZ Repair Right Anterior Chamber, Percutaneous Approach . https://doi.org/10.1186/s12893-018-0463-7, DOI: https://doi.org/10.1186/s12893-018-0463-7. Official websites use .govA CPT Codes. Prolapse of the rectum, long-term results of surgical treatment. The knots should sit between the margins of the mucosa which may require repositioning the tractor outside of the dentate line. @%OkPz0E,kn`4K0o]=m"'IT*c&)_'!`Qt"MV2B9v{=I]$WKpGj7 :}_,)1_8,UImv!UV(dh',;+`W(\b5Q# ( 30days morbidity according to Clavien-Dindo classification [4] and 30days mortality were recorded. Kim M, Reibetanz J, Schlegel N, et al. In our series although a statistically significant reduction in the ODS score was found, there was no change in any of the other parameters used to assess bowel and urinary function. <>/Metadata 4156 0 R/ViewerPreferences 4157 0 R>> The purpose of this incision is to have the anastomosis proximal to the puborectal muscle. Tl& We use cookies to enhance your browsing experience and provide you with additional functionality. 2014;16(6):45968. is entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and/or any other body layers necessary to reach and visualize the site of the procedure. Sign up to get the latest information about your choice of CMS topics. Surgical treatments proposed are divided in abdominal and perineal procedures. Recurrence after perineal rectosigmoidectomy: when and why? Comparison of the preoperative and postoperative obstructed defecation syndrome (ODS) scores. During the more commonly performed form of this procedure (Altemeier procedure), the surgeon pulls the rectum through the anus, removes a portion of the rectum and sigmoid and attaches the remaining rectum to the large intestine (colon). D'\=> MeSH Perineal approaches for the treatment of complete rectal prolapse. This is a review of 103 (99 women) consecutive patients (mean age, 68.9 y; range, 20-97 y) who underwent the Altemeier procedure between 2000 and 2009. Make a donation. Dis Colon Rectum. Prospective study in 54 consecutive patients. and transmitted securely. There are also multiple examples in the ICD-10-PCS Reference Manual to help you better understand the procedure approaches. When the walls of the rectum displace enough so that they extend out of the anus and are easy to see outside of the body, this is what is known as rectal prolapse. Post-operative complications at 30days occurred in 18 patients (38%). Rectal prolapse: a 10-year experience. Surgery puts the rectum back in place. Bookshelf Reviewing how a NFLs Team medical injuries can Impact the whole series, CBD vs. THC: 7 Things Every Beginner Should Know. Once the external prolapse has complete exposure, the Lone Star retractor is attached. Postoperatively the first defecation occurred at 24/48h in 27 (63%) patients, at 72h in 10 (23%) and on the fourth-sixth post-op day in 6 (14%). Surgical treatments proposed are divided in abdominal and perineal procedures. Poylin VY, Irani JL, Rahbar R, Kapadia MR. Gastroenterol Rep (Oxf). The colon carries waste to be expelled from the body. Gallo G, Martellucci J, Pellino G, Ghiselli R, Infantino A, Pucciani F, Trompetto M. Tech Coloproctol. Laparoscopic anterior rectopexy to the promontory for full-thickness rectal prolapse in 175 consecutive patients short- and long-term follow-up. Outcomes of rectal prolapse using the altemeier procedure. The first character always specifies the section. eCollection 2020 Jun. 2005;27(5):4149. Grade 4 occurred in 44-years old patient with an history of dementia, Parkinson, chronic bronchitis and recurrent ab aspiration pneumonias who presented with an aspiration pneumonia and lung failure. Epub 2019 May 9. Prospective comparison of faecal incontinence grading systems. No procedure is considered the best overall. ,Lm-Y6+k715AK.66c-')>9Vc Wy#Wp}0s. The Altemeier procedure for rectal prolapse provided excellent results across all age groups with minimal morbidity, allowing for short hospital stays and periods of convalescence. The datasets generated and analysed during the current study are available from the corresponding author; a copy of the data was add as additional supporting file. Wijffels N, Cunningham C, Dixon A, et al. endobj Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. HIA offers PRN support as well as total outsource support. Accessibility The Altemeiers procedure is an available low risk treatment that can be performed under regional anesthesia, recovery is rapid and it gives immediate relief of the prolapse itself. https:// Your surgeon will suggest the appropriate one for you based on your condition and your overall health. This approach includes procedures whereby the procedure is performed entirely by percutaneous endoscopic approach. government site. Dis Colon Rectum. It requires grasping the caudal wall. Lung Transplantation Services at UW Medical Center - Montlake. Twenty-eight (65%) patients had a previous history of cardiovascular disease, 13 (30%) a neurological or psychiatric disorder, and 30 (70%) had had previous pelvic surgery. % Wound infection. Privacy Rectal prolapse occurs when the rectum becomes stretched out and protrudes from the anus. official website and that any information you provide is encrypted 2022 Dec;38(6):415-422. doi: 10.3393/ac.2021.00262.0037. Rectal prolapse is not uncommon. An example of this is laparoscopic-assisted bowel resection/excision and nephroureterectomy via hand-assisted laparoscopy. 10 years experience from a UK tertiary centre. Its the procedure not the patient: the operative approach is independently associated with an increased risk of complications after rectal prolapse repair. So that you'll be as comfortable as possible during your stay, consider bringing: Rectal prolapse surgery can be done through the abdomen (rectopexy) or through the region around the anus (perineum). Which approach your surgeon uses depends on a number of factors, such as the size of your prolapse, your age, other health problems, your surgeon's experience and preferences, and equipment available. The Centers for Medicare and Medicaid Services (CMS) maintain the catalog in the U.S. releasing yearly updates. As for recurrence, the most logical treatment is a second Altemeier procedure. <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 576 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Ann Surg. hZeW Cite this article. The CMS ICD-10 Procedure Coding System (ICD-10-PCS) is a catalog of procedural codes used by medical professionals for hospital inpatient healthcare settings. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Google Scholar. Percutaneous endoscopic-assisted procedures are coded to the open approach as stated above. PMC Recent series (combined with levatorplasty = Altemeier procedure) revealed excellent results across a broader spectrum of patients and inspired this ongoing consecutive series of cases. Peri-operative data on 43 consecutive female patients were reviewed. Patient satisfaction was determined using a simple numerical scale from 0 (not satisfied) to 10 (completely satisfied). [5]. 45990 Anorectal EUA, no other procedure Anorectal Procedures 45999 Unlisted procedure, rectum Anorectal Procedures 46040 Abscess, I&D, perirectal, any type Anorectal Procedures 46200 Fissurectomy + flap Anorectal Procedures 46220 Papilla or tag, anal, excision Anorectal Procedures 46700 Stricture, anoplasty Anorectal Procedures  Fr&@I p6; a|=aj GLeh}H,\J+IhM)fJkM6=cpwMgw{ME4jpIr{`lj/zbv\Oi>"z. Kairaluoma MV, Kellokumpu IH. Surgical Approaches - Open vs. Percutaneous vs. An announcement was also made at the September 2017 ICD-10 Coordination and Maintenance Committee meeting that FY 2018 would be the last GEMs file update. Code History. ODS score decreased with respect to levatorplasty and the change was statistically significant instead of Vaizey score in which were not. Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. They found that a perineal approach was independently associated with a lower 30-day major and minor complication rate than any abdominal procedure. Ris F, Colin JF, Chilcott M, Remue C, Jamart J, Kartheuser A. Colorectal Dis. Data on 43 consecutive female patients undergoing Altemeiers procedure for complete rectal prolapse were reviewed. Unauthorized use of these marks is strictly prohibited. What if its a full thickness prolapse as is frequently the case? Dis Colon Rectum. Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Marzouk D, Ramdass MJ, Haji A, et al. Despite anatomical correction by surgery, patients frequently complain persisting pelvic floor symptoms and recurrences. They include rectal bleeding, symptoms of obstructed defecation, mucous discharge from the anus, and degrees of fecal incontinence. The average time to recurrence was 17months (SD 9.8- range 536). Reissman P, Weiss E, Teoh TA, Cohen SM, Wexner SD. 4 0 obj 2007;7(1):2432. This retrospective study was approved by the ethics committee of the Azienda Ospedaliera Nazionale ss. 2016;27(1):339. Tech Coloproctol. When reporting procedures on this list, facilities should capture both the CPT1 code representing the procedure performed and the . Inpatient medical coders and billers rely on the ICD-10-PCS, which is distinct from ICD-10-CM. Then it is followed by transection between the ligatures at the superior resection margin level. Altemeier's procedure for rectal prolapse: analysis of long-term outcome in 60 patients. I prefer the 45130 code as this says "excision of rectal procidentia." It doesn't necessarily mean proctectomy..If you excise the mucosa as in a Delorme, this is an excision of the procidentia in my opinion. Potential Risks Bleeding or hematoma development requiring reoperation. Perineal rectosigmoidectomy for rectal prolapse-the preferred procedure for the unfit elderly patient? A careful preoperative risk assessment of surgical and cardiopulmonary risks including ASA and functional status is mandatory to anticipate possible postoperative complications [20]. Each female had had a mean of 1.4 deliveries. Hu B, Zou Q, Xian Z, Su D, Liu C, Lu L, Luo M, Chen Z, Cai K, Gao H, Peng H, Cao W, Ren D. Gastroenterol Rep (Oxf). With bipolar scissors, the rectal wall undergoes transection. 2003 Jul-Sep;68(3):185-91. Perineal rectosigmoidectomy (Altemeier's procedure): a review of physiology, technique and outcome A. P. Zbar, S. Takashima, T. Hasegawa & K. Kitabayashi Techniques in Coloproctology 6 , 109-116 ( 2002) Cite this article 1043 Accesses 53 Citations Metrics Abstract. 45130. 2004;38(3):43844. 2005;140(1):6373.