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Perineal rectosigmoidectomy (Altemeier) is the choiceprocedure for rectalprolapse in the elderly. The aim of thisprospective observational study was to evaluate its long-term actuarial recurrence risk, the impact of rectosigmoid resection length and associated levatorplasty on recurrence rate and the continence improvement.The perioperative and long-term data of all patients undergoing Altemeierprocedure since 1992 were analyzed with regard to mortality, morbidity, anorectal function and recurrence rate.Sixty patients (median age: 77 years [35-98]) underwent rectosigmoid resection (median length: 14 cm [6-60]), with associated levatorplasty in 21 cases (35%). Overall mortality and morbidity were 1.6% and 11.6% respectively. Manometry showed increased anal sphincter basalpressure and maximal squeezepressure. We observed a decrease in postoperative rectal compliance (P = 0.002). Age, gender,prolapse duration before surgery, levatorplasty and length of resected segment had no statistically significant influence on recurrence. Continence improvement occurred in 62% of all patients and was stable over time (median follow-up: 48 months [1-186]). Actuarial recurrence rate was 14% at 4 years.Long-term recurrence rate after Altemeierprocedure was acceptable and was neither linked to resected segment length nor to associated levatorplasty. Continence improvement remained stable over time.