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What Is Proctosigmoidectomy?

Proctosigmoidectomy is surgery that removes part or all of the sigmoid colon together with part of the rectum. The procedure can be performed through an abdominal approach or, for selected rectal prolapse operations, through the perineum. Bowel continuity can be restored with a colorectal or coloanal anastomosis when the remaining bowel and sphincter are suitable. Some operations instead create a temporary or permanent stoma depending on the disease and surgical circumstances.

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What Is Proctosigmoidectomy?

Proctosigmoidectomy is surgery that removes part or all of the sigmoid colon together with part of the rectum. The procedure can be performed through an abdominal approach or, for selected rectal prolapse operations, through the perineum. Bowel continuity can be restored with a colorectal or coloanal anastomosis when the remaining bowel and sphincter are suitable. Some operations instead create a temporary or permanent stoma depending on the disease and surgical circumstances.

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Why Is Proctosigmoidectomy Performed?

The procedure can be used for selected cancers of the rectosigmoid region, severe diverticular disease, rectal prolapse, and other diseases affecting both the sigmoid colon and rectum. The amount of bowel removed depends on disease location, blood supply, cancer margins, bowel function, and the reconstruction planned afterward. A perineal rectosigmoidectomy, commonly associated with the Altemeier procedure, is one option for selected full-thickness rectal prolapse. Cancer operations can require lymph-node removal and mesorectal dissection in addition to bowel resection.

How Is Proctosigmoidectomy Performed?

During an abdominal proctosigmoidectomy, the surgeon mobilizes the sigmoid colon and rectum and divides the blood vessels serving the portion to be removed. The diseased bowel is removed, and the remaining colon can be connected to the residual rectum or anal canal with a stapled or hand-sewn anastomosis. A diverting ileostomy can be added when a low anastomosis needs temporary protection. In a perineal operation for prolapse, the prolapsed rectum and distal sigmoid are removed from below and the bowel is reconnected through the perineal approach.

What Is Recovery Like After Proctosigmoidectomy?

Patients are monitored for bowel function, pain, infection, bleeding, urinary problems, hydration, and healing of any bowel connection. Diet and walking are advanced as intestinal function returns. Bowel frequency, urgency, constipation, or continence can change depending on how much rectum was removed and the reason for surgery. Patients with a temporary stoma require stoma care and later evaluation before reversal is considered.

What Are the Risks and Complications?

Possible complications include bleeding, infection, bowel obstruction, blood clots, urinary problems, and injury to nearby pelvic structures. Anastomotic leakage can cause pelvic infection, abscess, sepsis, or the need for drainage, diversion, or reoperation. Long-term problems can include anastomotic stricture, altered bowel habits, fecal urgency, constipation, or incontinence. Rectal prolapse can recur after a perineal proctosigmoidectomy, while cancer surgery carries additional risks related to pelvic dissection and disease recurrence.

Frequently Asked Questions About Proctosigmoidectomy

What parts of the bowel are removed during proctosigmoidectomy?

The operation removes sigmoid colon and rectum. The exact length of each portion varies according to the disease and the reconstruction required.

Is proctosigmoidectomy always performed through the abdomen?

No. Many operations use an abdominal approach, but perineal rectosigmoidectomy can be performed from below for selected patients with full-thickness rectal prolapse.

What is the Altemeier procedure?

The Altemeier procedure is a perineal rectosigmoidectomy used to treat full-thickness rectal prolapse by removing the prolapsed rectum and distal sigmoid and reconnecting the bowel.

Can a stoma be needed after proctosigmoidectomy?

Yes. A temporary diverting stoma or permanent colostomy can be required depending on anastomotic risk, disease, bowel condition, and the specific operation performed.

References

Rectal Prolapse. American Society of Colon and Rectal Surgeons. https://fascrs.org/Web/Web/Patients/Diseases-and-Conditions/A-Z/Rectal-Prolapse.aspx. Date Accessed August 13, 2026.

Perineal rectosigmoidectomy (Altemeier's procedure). PubMed. https://pubmed.ncbi.nlm.nih.gov/12402057/. Date Accessed August 13, 2026.

Altemeier procedure for rectal prolapse: multicentre study of outcome and recurrence. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC10364761/. Date Accessed August 13, 2026.

Long-term outcome of perineal rectosigmoidectomy for rectal prolapse. PubMed. https://pubmed.ncbi.nlm.nih.gov/27345263/. Date Accessed August 13, 2026.

Hartmann's Pouch Procedure (Proctosigmoidectomy). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/21891-hartmanns-procedure. Date Accessed August 13, 2026.