Perineal proctosigmoidectomy

These figures depict the basic approach to the perineal proctosigmoidectomy, also known as the Altemeier procedure.
(Panel A) An incision is made through the seromuscular layer anteriorly, within 1 to 2 cm of the dentate line.
(Panel B) The incision is extended circumferentially.
(Panel C) The prolapsed rectum is everted and fully mobilized. The peritoneal reflexion is incised.
(Panel D) The mesorectum is divided. Full-thickness, nonabsorbable interrupted sutures are placed between the divided bowel and residual cuff.
(Panel E) The anastomosis is completed.