Redo perineal rectosigmoidectomy with posterior levatorplasty for recurrent rectal prolapse

Rectal prolapse is an uncommon condition mostly affecting the elderly and women populations. Surgical repair is the recommended treatment of choice for those patients who develop full thickness rectal prolapse. The two most common surgical approaches are trans abdominal and perineal. Recurrences of prolapse occur in 5–30% of patients and are higher for perineal approaches. An 83-year-old female with a history of previous Altemeier perineal proctectomy and posterior levatorplasty three years prior presented with recurrent rectal prolapse associated with chronic diarrhea, tenesmus, and mild incontinence. She underwent an uncomplicated redo Altemeier perineal proctosigmoidectomy and posterior levatorplasty. The patient recovered well and was prolapse free at one-year follow-up with significantly reduced associated symptoms. Redo perineal procedures are feasible, similar if not identical to primary resections, and are often easier to perform because the hernia sac is often easily identified. The same principles of perineal primary repair should be used in a redo perineal procedure.