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Delorme’s vs. Altemeier’s in the management of rectal procidentia: systematic review and meta-analysis

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Abstract

Background

Rectal prolapse is a distressing condition for patients and no consensus exists on optimal surgical management. We compared outcomes of two common perineal operations (Delorme’s and Altemeier’s) used in the treatment of rectal prolapse.

Methods

A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme’s and Altemeier’s procedures were extracted. Primary outcomes included recurrence rate, anastomotic dehiscence rate and mortality rate. The secondary outcomes were total operative time, volume of blood loss, length of hospital stay and coloanal anastomotic stricture formation. Revman 5.3 was used to perform all statistical analysis.

Results

Ten studies with 605 patients were selected; 286 underwent Altemeier’s procedure (standalone), 39 had Altemeier’s with plasty (perineoplasty or levatoroplasty), and 280 had Delorme’s. Recurrence rate [OR: 0.66; 95% CI [0.44–0.99], P = 0.05] was significantly lower and anastomotic dehiscence [RD: 0.05; 95% CI [0.00–0.09], P = 0.03] was significantly higher in the Altemeier’s group.

However, sub group analysis of Altemeier’s with plasty failed to show significant differences in these outcomes compared with the Delorme’s procedure. Length of hospital stay was significantly more following an Altemeier’s operation compared with Delorme’s [MD: 3.05, 95% CI [0.95 – 5.51], P = 0.004].

No significant difference was found in total operative time, intra-operative blood loss, coloanal anastomotic stricture formation and mortality rates between the two approaches.

Conclusions

A direct comparison of two common perineal procedures used in the treatment of rectal prolapse demonstrated that the Altemeier’s approach was associated with better outcomes. Future, well-designed high quality RCTs with long-term follow up are needed to corroborate our findings.

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Data Availability

The data that support the findings of this study are available from the corresponding author, PB , upon reasonable request.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK

    Pratik Bhattacharya, Shafquat Zaman, Sophie Randle, Diwakar Ryali Sarma & Rajeev Peravali

  2. Department of General Surgery, Great Western Hospitals NHS Foundation Trust, Swindon, UK

    Mohammad Iqbal Hussain

  3. Department of General Surgery, Craigavon Area Hospital, Portadown, Northern Ireland, UK

    Yousaf Tanveer

  4. Department of General Surgery, The Dudley Group NHS Trust, Russells Hall Hospital, Dudley, West Midlands, UK

    Nameer Faiz

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  1. Pratik Bhattacharya
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Contributions

Study conception and design: PB, MIH, RP. Acquisition of data: PB, MIH, SR. Analysis and interpretation of data: PB, MIH. Drafting of manuscript: All authors. Critical revision of manuscript: All authors. Approval of final manuscript: All authors. PB and MIH had equal contribution and proposing joint first authorship.

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Correspondence to Pratik Bhattacharya.

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Mr Rajeev Peravali.

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Pratik Bhattacharya and Mohammad Iqbal Hussain had equal contribution proposing joint first authorship.

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Bhattacharya, P., Hussain, M.I., Zaman, S. et al. Delorme’s vs. Altemeier’s in the management of rectal procidentia: systematic review and meta-analysis. Langenbecks Arch Surg 408, 454 (2023). https://doi.org/10.1007/s00423-023-03181-z

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