The Midwest Surgical Association
The Delorme repair for full-thickness rectal prolapse: a retrospective review

https://doi.org/10.1016/j.amjsurg.2008.11.012Get rights and content

Abstract

Background

The purpose of this study was to assess our colorectal surgical training program experience with the Delorme procedure for complete rectal prolapse.

Methods

Consecutive patients were identified from a surgical database and evaluated by chart review.

Results

Seventy-six patients with a mean follow-up period of 3.6 years were included. Outcomes included a recurrence rate of 14.5%, an overall complication rate of 25%, and a surgical site-specific complication rate of 8%. For patients younger than 50 years old (mean age, 36 y; range, 19–49 y), the recurrence rate was 8% with a mean follow-up period of 4.1 years. Their total complication rate was 15%, with no surgery site-specific complications.

Conclusions

Our results are consistent with previously published experiences in that most preoperative evacuatory symptoms resolve with repair of the prolapse, and serious complications are uncommon. The observation that recurrence and complication rates may be lower in younger medically fit patients suggests the Delorme repair need not be restricted specifically to older, medically unfit patients.

Section snippets

Patients and Methods

A retrospective chart review of 76 consecutive patients who underwent the Delorme repair between March of 1994 and June of 2006 was performed. Patients without full-thickness rectal wall prolapse were excluded. Patients were not excluded if they came to Delorme after a previously failed procedure for prolapse. Preoperative symptoms including bleeding, incontinence, and constipation were obtained from the patient chart. Preoperative history of chronic obstructive pulmonary disease,

Results

A total of 76 patients underwent the Delorme procedure for full-thickness rectal prolapse during the period described. Seventy patients underwent a primary prolapse procedure and 6 had Delorme as a secondary procedure after a prior failed prolapse procedure. The median age of the patients was 74 years (range, 16–93 y). Thirteen patients (17%) were younger than the age of 50. Only 5 of the patients were male. Follow-up data were available for all 76 patients.

Postoperative data were available for

Comments

This series of patients represents our experience using the Delorme procedure for the repair of full-thickness rectal prolapse. This series differs from many others by specifically reporting and emphasizing outcomes in younger, medically fit patients. Many previous investigators have reported young patients undergoing Delorme procedure.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 Even the eponymous Edmund Delorme's first case report was of a 22-year-old patient.

Many investigators have suggested that

Conclusion

The Delorme procedure's utility in older, less fit patients is reinforced. No statistically significant predictors of complication, readmission, or recurrence were identified in either the cohort at large or in the younger age subset. There is a trend towards more frequent recurrence early in a surgeon's learning curve. The Delorme group in general has outcomes comparable with historical Altemeier procedure outcomes without the risk of a full-thickness anastomosis. The recurrence rate in

References (29)

  • A. Dippolito et al.

    Anterior modification of the Delorme procedure provides equivalent results to Delorme procedure in treatment of rectal outlet obstruction

    Curr Surg

    (2005)
  • E. Delorme

    On the treatment of total rectal prolapse of the rectum by excision of the rectal mucous membranes or recto-colic

    Dis Colon Rectum

    (1985)
  • A.M.I. Watts et al.

    Evaluation of Delorme's procedure as a treatment for full-thickness rectal prolapse

    Br J Surg

    (2000)
  • B.P. Watkins et al.

    Long-term follow-up of the modified Delorme procedure for rectal prolapse

    Arch Surg

    (2003)
  • G.C. Oliver et al.

    Delorme's procedure for complete rectal prolapse in severely debilitated patients: an analysis of 41 cases

    Dis Colon Rectum

    (1994)
  • J.R.T. Monson et al.

    Delorme's operation: the first choice in complete rectal prolapse?

    Ann R Coll Surg Engl

    (1986)
  • J.P. Lechaux et al.

    Results of Delorme procedure for rectal prolapse: advantages of a modified technique

    Dis Colon Rectum

    (1998)
  • H. Liberman et al.

    Evaluation and outcome of the Delorme procedure in the treatment of rectal outlet obstruction

    Dis Colon Rectum

    (2000)
  • M. Pescatori et al.

    Complications and recurrence after excision of rectal internal mucosal prolapse for obstructed defecation

    Int J Colorectal Disease

    (2006)
  • K.M. Kling et al.

    The Delorme procedure: a useful operation for complicated rectal prolapse in the elderly

    Am Surg

    (1996)
  • S.A. Tobin et al.

    Delorme operation for rectal prolapse

    Br J Surg

    (1994)
  • B.E. Uhlig et al.

    The modified Delorme operation: its place in surgical treatment for massive rectal prolapse

    Dis Colon Rectum

    (1979)
  • T.E. Madiba et al.

    Surgical management of rectal prolapse

    Arch Surg

    (2005)
  • C. Marceau et al.

    Complete rectal prolapse in young patients: psychiatric disease a risk factor of poor outcome

    Colorectal Dis

    (2005)
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