altemeier procedure pcs code altemeier procedure pcs code

4 0 obj Practice guidelines recommend perineal rectosigmoidectomy (Altemeier procedure) for rectal prolapse greater than 5 cm 1.However, anastomotic complications are a cause for concern as they can be as common as one in three cases 2-4.In this multicentre retrospective study, 318 patients from 10 hospitals (from 2010 to 2021) were analysed. Ann Surg. Bookshelf 2016;20:695700. 2023 ICD-10-PCS Procedure Code 0DTP0ZZ Resection of Rectum, Open Approach 2016 2017 2018 2019 2020 2021 2022 2023 Billable/Specific Code ICD-10-PCS 0DTP0ZZ is a specific/billable code that can be used to indicate a procedure. 2004;38(3):43844. Join 50,000 healthcare professionals and get our weekly newsletter delivered to your inbox. Moreover, a recent Cochrane review failed to confirm the superiority of transabdominal over perineal procedures, due to the heterogeneity and poor quality of the available studies [31]. government site. Kairaluoma MV, Kellokumpu IH. Mayo Clinic. (Additionalfile1). The majority of rectal prolapse incidents have successful treatment results requiring surgery. Examples of percutaneous approach are arterial/venous catheter placement, coil embolization of artery, drainage of subdural hemorrhage via burr hole, laser trabeculoplasty, and PTCA of the coronary artery. %PDF-1.5 A small nick in the skin or small incision made in the skin does not constitute an open approach. Comparison between pre-operative and post-operative functional scores was performed using the paired t-test or Wilcoxons rank sum test for paired data. 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. Color Dis. For most people, rectal prolapse surgery relieves symptoms and improves fecal incontinence and constipation. How to do an Altemeier perineal rectosigmoidectomy for full-thickness rectal prolapse Authors Shinichiro Sakata 1 , Nicholas P McKenna 1 , Ahmed Allawi 1 , Anne-Lise D D'Angelo 1 , Heidi K Chua 1 , Eric J Dozois 1 Affiliation 1 Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA. Despite anatomical correction by surgery, patients frequently complain persisting pelvic floor symptoms and recurrences. 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. Although anyone of any age could suffer from this condition, it is more common in elderly women. 2015;19(9):5215. Does anyone out there know if the procedure code 45130, altemeier procedure for rectal prolapse when done with posterior levatorplasty includes the levatorplasty procedure? They found that a perineal approach was independently associated with a lower 30-day major and minor complication rate than any abdominal procedure. Thanks S sscott@hogonc.com Networker The incision location is at the tip of the prolapse with the aid of Allis clamps under gentle traction. The procedure is known as the Altemeier perineal rectosigmoidectomy. How Monitoring Your HRV Can Help You Keep Track of Your Overall Health with Welltory, 8 Common Practices That Actually Cause Damage To Your Oral Health, Travel Nursing Skills: 6 Skills & Qualities, No, I Dont Want To Receive Healthcare Breaking News Reports. Validation of the international consultation on incontinence questionnaire-short form(ICIQ-SF) for portuguese. The suture line receives inspection with a speculum and an easy-flow drain goes in the anal canal. You can decide how often to receive updates. Recent series (combined with levatorplasty = Altemeier procedure) revealed excellent results across a broader spectrum of patients and inspired this ongoing consecutive series of cases. Surgery puts the rectum back in place. Furthermore functional outcomes (constipation, continence and outlet obstruction) after laparoscopic ventral rectopexy were at least equivalent as the ones after open abdominal or perineal procedures [36, 37]. All patients were classified using the ODS score described by Altomare et al. Google Scholar. We made the GEMs files available for FY 2016, FY 2017 and FY 2018. 1995 Jun;5(3):217-8. The Altemeier procedure for rectal prolapse: an operation for all ages The Altemeier procedure for rectal prolapse: an operation for all ages Author William C Cirocco 1 Affiliation 1 Shawnee Mission Medical Center, Shawnee Mission, Kansas, USA. Surgical site and urinary tract infection were considered to be minor. Art. 2004;8(1):39. Please enable it to take advantage of the complete set of features! Every year, in the OPPS rule, Medicare publishes a list of CPT1 and HCPCS codes that are designated as device-intensive procedures. Rectal prolapse surgery is a procedure to repair rectal prolapse, which occurs when the last part of the large intestine (the rectum) stretches and protrudes from the anus. If procedures are performed using the open approach with percutaneous endoscopic assistance or hand-assisted laparoscopy they are coded as open. 2020 Apr 13;54:22-25. doi: 10.1016/j.amsu.2020.03.011. The mean time for the operation was 97.7 minutes (range, 50-180 min) with a mean 7.2 cm of rectum resected (range, 2.5-26.7 cm). Chua HK (expert opinion). 2022 Feb 21;10(1):goac007. American Society of Colon & Rectal Surgeons. All authors gave their final approval of the version to be published and are co-authors of the present paper. endobj Potential Risks Bleeding or hematoma development requiring reoperation. 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.  Fr&@I p6; a|=aj GLeh}H,\J+IhM)fJkM6=cpwMgw{ME4jpIr{`lj/zbv\Oi>"z. We also use third-party cookies that help us analyze and understand how you use this website. endobj The ICD-10-PCS is a procedure classification published by the United States for Laparoscopic anterior rectopexy to the promontory for full-thickness rectal prolapse in 175 consecutive patients short- and long-term follow-up. Color Dis. This may be further supported by the finding in the present study of an improvement in the ODS which will give some symptomatic relief. The mean follow-up was 43 months (range, 3 mo to 10 y). Endoanal ultrasound (EUS), contrast defecography, magnetic resonance imaging (MRI)- defecography, colonic motility and anorectal manometric studies were not routinely performed in all patients, usually owing to their advanced age and the obvious diagnosis of rectal prolapse on observation. Patient satisfaction showed a mean of 8.8 and 6.4 respectively in patients without and with recurrences (p=0.012). Before Once the external prolapse has complete exposure, the Lone Star retractor is attached. As stated in the FY 2016 IPPS/LTCH PPS final rule (80 FR 49388), the GEMs have been updated on an annual basis as part of the ICD-10 Coordination and Maintenance Committee meetings process and will continue to be updated for approximately 3 years after ICD-10 is implemented. Altemeiers procedure had in our series low complications rate and no mortality. Here is a breakdown of the seven major steps commonly followed in the treatment of rectal prolapse. Step 1 - The Anal Retractor Insertion and Rectal Wall Incision There are two parts to the first step of this procedure. Recurrence of rectal prolapse after surgery occurs in about 2% to 5% of people. 2023 Coding & Payment Quick Reference Select Enteral Feeding Procedures Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The mean preoperative scores for constipation and incontinence, the ICIQ SF score and preoperative residual urinary volume score are given in Table1. uLj/nHFtGi=OijL9N2Jwh[27gXA{8H@j.aHMdJ,348aJ^Lhx=8Yet49/HD6*D>n@Z{{K5#H&5TqrB8H.GhXCvFq((X 7 For the past 30 years, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. Functional results analyzing bowel and urinary function patient satisfaction were investigated. Ann Med Surg (Lond). What if its a full thickness prolapse as is frequently the case? Kim M, Reibetanz J, Schlegel N, et al. 2008;10(1):848. 2019 Nov;23(11):1065-1072. doi: 10.1007/s10151-019-02100-z. of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy, Department of Biostatistics, S.Gaudenzio Clinic, Policlinico di Monza, Italy, Department of General Surgery, University of Catanzaro, Catanzaro, Italy, You can also search for this author in An official website of the United States government. ADPtFnnV D%v-_~"`H=F;h/!3vt0a9k`9SL2n Perineal rectosigmoidectomy for primary and recurrent rectal prolapse: are the results comparable the second time? Ramanujam PS, Venkatesh KS, Fietz MJ. 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. Unfortunately, we have no data on their recurrence state. M\E-"S0@/RL*b\Dw!Vc#'/fp(XV=r- #yOq|dxW[%u!fU" *tE>I%`kx{x"G'|J! Epub 2019 May 9. Perineal rectosigmoidectomy for primary and recurrent rectal prolapse: are the results comparable the second time? The ICIQ SF score showed that urinary incontinence improved in one patient, worsened in five, and in 28 there was no change with a median pre-operative ICIQ SF score of 0 and no difference postoperatively (p=0.062). 2014;16(11):9204. It appears to be slightly more common in people who have the perineal procedure compared with an abdominal one. 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), 2021 Official ICD-10-PCS Coding Guidelines - Updated December 1, 2020 (PDF), 2021 ICD-10-PCS Code Tables and Index - Updated December 1, 2020 (ZIP), 2021 ICD-10-PCS Addendum - Updated December 1, 2020 (ZIP), 2021 ICD-10-PCS Codes File - Updated December 1, 2020 (ZIP), 2021 ICD-10-PCS Conversion Table - Updated December 1, 2020 (ZIP), 2021 ICD-10-PCS Order File (Long and Abbreviated Titles) - Updated December 1, 2020 (ZIP), 2021 Version Update Summary - Updated December 1, 2020 (PDF). Altomare D, Spazzafumo L, Rinaldi M, et al. The three axial perineal evaluation (TAPE) score: a new scoring system for comprehensive evaluation of pelvic floor function. HIA offers PRN support as well as total outsource support. Demographic data including age, number and type of delivery, comorbidity, previous pelvic or perineal surgery, duration of symptoms, bowel function including frequency of defecation, urgency and incontinence, urinary function, body mass index (BMI) and American Society of Anesthesiologists (ASA) score were recorded. The authors declare that they have no competing interests. Make a donation. Note: There is no GEMs file. 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. Altemeier procedure, perineal proctosigmoidectomy. Technical and functional results after laparoscopic rectopexy to the promontory for complete rectal prolapse. These cookies do not store any personal information. Altemeiers procedure for rectal prolapse: analysis of long-term outcome in 60 patients. Bethesda, MD 20894, Web Policies Color Dis. Data on perioperative management including bowel preparation, antibiotic and thromboembolic prophylaxis, and type of anesthesia were also collected. A careful preoperative risk assessment of surgical and cardiopulmonary risks including ASA and functional status is mandatory to anticipate possible postoperative complications [20]. Surgical management of rectal prolapse. According to many researchers, there are between three and five ways in which the rectal prolapse can occur. Br J Surg. 2007 Aug;132(4):350-7. doi: 10.1055/s-2007-981237. Epub 2019 Nov 13. 2022 Dec;38(6):415-422. doi: 10.3393/ac.2021.00262.0037. These are but a few examples of these selected approaches. The anastomosis must be tension-free at the time. Methods: FOIA The score on patients satisfaction and the urinary retention score are not validated. 2003 Jul-Sep;68(3):185-91. The ASA score was I [6 patients], II [21], III [15] and IV [1]. Perineal approaches for the treatment of complete rectal prolapse. is for limited procedures only in the Female Reproductive System. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2012;49(1):1140. This content does not have an Arabic version. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. The aim of this retrospective study was to evaluate morbidity, mortality, postoperative function and recurrences in patients treated by Altemeiers rectosigmoidectomy for complete rectal prolapse in a referral center for pelvic floor functional disorders. The limbs of the levator ani are then adjoined in the midline anterior to the bowel and near the gap in the pelvic diaphragm. 2005 Jan;140(1):63-73. doi: 10.1001/archsurg.140.1.63. Using digital means, the lateral ligaments experience transection with their pathways running between the ligatures. You can decide how often to receive updates. 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]. That being said, there is evidence that there is a recurrence rate following the procedure and the operation is considered unpredictable regarding the restoration of continence. Post-operative complications at 30days occurred in 18 patients (38%). 2012 Sep;14(9):1106-11. doi: 10.1111/j.1463-1318.2011.02904.x. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Accessibility Fleming et al. endobj 1). Wound infection. Provided by the Springer Nature SharedIt content-sharing initiative. The aim of surgical repair is to reduce the mobility of the rectum and sigmoid colon by fixation with or without removal of the prolapsing rectum and sigmoid colon and to give mechanical support to sphincters and pelvic floor [3]. Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. hZeW There is no GEMs file. government site. [?mgf|uH Examples include knee arthroscopy and laparoscopic cholecystectomy. There are a number of ways to do rectal prolapse surgery. Then it is followed by transection between the ligatures at the superior resection margin level. PubMed Central 1999;44(1):7780. 1 0 obj 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%). means youve safely connected to the .gov website. There are two parts to the first step of this procedure. When clients can depend on quality services delivered the right way, they find success, and thats how we measure our own. When reporting procedures on this list, facilities should capture both the CPT1 code representing the procedure performed and the . The Centers for Medicare and Medicaid Services (CMS) maintain the catalog in the U.S. releasing yearly updates. Epub 2018 Dec 15. As the transection is performed, the lumen should be opened step-by-step from 12 oclock. This approach has intensified the controversy because it has decreased the morbidity of the abdominal approach. Careers. But in general, rectal prolapse surgery risks include: To prepare for rectal prolapse surgery, your doctor may ask that you: You'll spend one or more days in the hospital after rectal prolapse surgery. https:// Bookshelf Experience at a colon and rectal surgery service]. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). This repair is typically reserved for those who are not candidates for open or laparoscopic repair. The high rate of recurrence at four years from surgery is likely to be multifactorial. statement and Ann Coloproctol. This aids in exposing the dentate line. Epub 2021 Oct 21. <>>> Day case robotic ventral rectopexy compared with day case laparoscopic ventral rectopexy: a prospective study. 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. At the same follow-up there were 12 (35%) cases of recurrence with an estimated risk at 48months of 40%. S Rita Clinic, Vercelli, Italy, Mario Trompetto,Roberta Tutino,Alberto Realis Luc,Gaetano Gallo&Giuseppe Clerico, Dept. There are also multiple examples in the ICD-10-PCS Reference Manual to help you better understand the procedure approaches. 1983;26(12):78991. Altemeier Procedure for Full-thickness Rectal Prolapse Complicated by Ischemic Stricture - YouTube This edited video shows the performance of an Altemeier Procedure for a patient with. The average duration of symptoms was 2years. There is tension at both ends and this will open the anal ring to where it appears circular. The average BMI was 22,2 ( 4.4). Its the procedure not the patient: the operative approach is independently associated with an increased risk of complications after rectal prolapse repair. 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. endobj Manage cookies/Do not sell my data we use in the preference centre. PubMedGoogle Scholar. Surgical Approaches - Open vs. Percutaneous vs. Ann Coloproctol. Risks vary, depending on surgical technique. You'll begin by drinking clear liquids and transition to solid foods. All patients had a coloanal hand sewn anastomosis and in 25 (58%) a levatorplasty was also performed. Gopal KA, Amshel AL, Shonberg IL, et al. The procedure is known as the Altemeier perineal rectosigmoidectomy. Discuss your options with your surgeon. 2017;60(11):112131. The 2022 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2022. SEER Program Coding and Staging Manual 2021 Appendix C: Surgery Codes 1 . Hammond K, Beck DE, Margolin DA, et al. Three patients experienced a worsening and in ten there was no change. endobj The 2020 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2020. % ICD-10 Procedure Coding System (ICD-10-PCS) was released in 1998, with PCS codes and guidelines updated every year. There were no statistically significant differences between patients with and without recurrence regarding age (p=0.188), BMI (p=0.864), ASA score (p=0.433), recurrent prolapse (p=0.398), previous hysterectomy (p=0.705), length of resected bowel (p=0.126), and levatorplasty (p=0.304) (Table2). <>/Metadata 4156 0 R/ViewerPreferences 4157 0 R>> coding and reporting using the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS). Accessed March 22, 2021. 08Q23ZZ is a specific/billable code that can be used to indicate a procedure. One patient showed an improvement in urinary retention but in all other patients the score was unchanged (p=1.000). General anesthesia was used in 18 (42%) patients and a spinal block in 25 (58%). Gallo G, Martellucci J, Pellino G, Ghiselli R, Infantino A, Pucciani F, Trompetto M. Tech Coloproctol. Stitching of both limbs of the levator ani happens now and the Douglas pouch elevates by anchoring the peritoneum to the sigmoid anterior wall with the sutures placed earlier in the procedure. The files in the Downloads section below contain information on the ICD-10-PCS COVID-19 updates effective with discharges on and after January 1, 2021. These findings support the results obtained in the present study which included a rate of major complications of 2.3% (one patient), which were not related to the ASA score, BMI or age, and no 30days mortality. At follow-up any change in pelvic floor function and recurrences were determined. Some options include general anesthesia, in which you're asleep, or a spinal block, in which your lower half is numb. (Related-Samples Sign Test for paired data), Comparison of the preoperative and postoperative Vaizey scores. Altemeiers procedure can be carried out under spinal anesthesia, avoiding the trauma of a laparotomy and permitting rapid recovery of alimentary function and mobility. 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 Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier. Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Get new exclusive access to healthcare business reports & breaking news. Statistical analysis: Descriptive data are presented as parametric data and non-parametric data. INDICATIONS This 74-year-old female has been dealing with what she thought was hemorrhoids for several years off and on. All patients received a complete bowel preparation, antibiotic prophylaxis (Cefazolin and Metronidazole) and thromboembolic prophylaxis (low-molecular-weight heparin). Chivate SD, Chougule MV, Chivate RS, Thakrar PH. Recurrences in our series occurred in 35% of cases, with an estimated risk of at 48months of 40% (Table4) [10,11,12,13,14,15,16,17,18, 24,25,26,27,28,29,30]. Breaking industry news, startup innovation alerts & emerging HealthTech News. D'Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. ( Long term follow-up was performed in 34 available patients with three patients lost to follow up and six deceased for reasons related to their ages and comorbidity not related to the surgical procedure (they would have had at the time of long term follow-up an average age of 90years old with a median of 91years old) being excluded from the analysis. There was no statistically significant difference in the Vaizey score before and after surgery (p=1.000) (Fig. Dis Colon Rectum. Varma MG, et al. ARL, RT, GG and EN gave substantial contribution to the acquisition, analysis and interpretation of data. Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. As previously reported, six patients were deceased and three patients were lost to follow up leaving 34 with a median follow-up of 49 (2135) months. In response to the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services (CMS) is implementing 12 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 August 01, 2020. Google Scholar. The etiology is multifactorial and includes weakness of the pelvic floor, chronic constipation, multiple pregnancies, previous pelvic surgery and a deep pouch of Douglas [2]. Dis Colon Rectum. Perineal rectosigmoidectomy to treat external full-thickness rectal prolapse was first described by Altemeier in 1952 [ 4 ]. 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. Arch Surg. The overall median decrease in ODS score was 1.5. Roberta Tutino. 30days morbidity according to Clavien-Dindo classification [4] and 30days mortality were recorded. It was retrospective and the follow up was not performed in all patients. Surg Endosc. J Anus Rectum Colon. Dindo D, Demartines N, Clavien PA. wcirocco27@yahoo.com PMID: 21178855 DOI: 10.1007/DCR.0b013e3181f22cef Abstract The Mann-Whitney U-Test was used to evaluate patient satisfaction regarding recurrence. Excision Procedures on the Rectum. It requires grasping the caudal wall. This site complies with the HONcode standard for trustworthy health information: verify here. The https:// ensures that you are connecting to the 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. Conclusions: In literature morbidity ranges from 3 to 35% and mortality is very unfrequently reported (Table3) [10,11,12,13,14,15,16,17,18]. Pre and post-operative functional scores and data above recurrences and time to recurrences collected from each patient. There was no mortality, minimal morbidity (14%), and no recurrence. Surg Endosc. Examples of external approach procedures are closed fracture reduction, laceration repair of skin or mucous membranes, and excisional debridement of skin only. See: Altemeier operation . All rights reserved. Recurrence after perineal rectosigmoidectomy: when and why? Color Dis. 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. 8600 Rockville Pike Trompetto, M., Tutino, R., Realis Luc, A. et al. Acta Chir Iugosl. Rectal prolapse occurs when the rectum becomes stretched out and protrudes from the anus. <>/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>> Specific Documentation Needed for Accurate Coding. evaluated the perioperative outcome of patients with complete rectal prolapse from the American College of Surgeon National Surgical Quality Improvement Program (NSQIP) to determine the safety of different surgical approaches. Gut. 2011;13:5616. Kimmins MH, Evetts BK, Isler J, et al. [Surgical treatment of rectal prolapse with transanal resection according to Altemeier. 45130. As for recurrence, the most logical treatment is a second Altemeier procedure. We made the GEMs files available for FY 2016, FY 2017 and FY 2018.