The goal of Perineal rectosigmoidectomy is to resect, or remove, the redundant bowel. This is done through the perineum. The lower rectum is anchored to the sacrum through fibrosis in order to prevent future prolapse. The full thickness of the rectal wall is incised at a level just above the dentate line. Redundant rectal and sigmoid wall is removed and the new edge of colon is reconnected (anastomosed) with the anal canal with stitches or staples. This procedure may be combined with levatorplasty, to tighten the pelvic muscles. A combined a perineal proctosigmoidectomy with anterior levatorplasty is also called an Altemeier procedure. Levatorplasty is performed to correct levator diastasis which is commonly associated with rectal prolapse. Perineal rectosigmoidectomy was first introduced by Mikulicz in 1899, and it remained the preferred treatment in Europe for many years. It was Popularized by Altemeier. The procedure is simple, safe and effective. Continence levatorplasty may enhance restoration of continence (2/3 of patients). Complications occur in less than 10% of cases, and include pelvic bleeding, pelvic abscess and anastomotic dehiscence (splitting apart of the stitches inside), bleeding or leak at a dehiscence Mortality is low. Recurrence rates are higher than for abdominal repair, 16-30%, but more recent studies give lower recurrence rates. Additional levatorplasty can reduce recurrence rates to 7%.