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Techniques in Coloproctology

, Volume 19, Issue 9, pp 521–525 | Cite as

Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier

  • F. Elagili
  • B. Gurland
  • X. Liu
  • J. Church
  • G. OzunerEmail author
Original Article

Abstract

Purpose

Data comparing surgical outcomes and quality of life (QOL) following perineal repair of rectal prolapse are limited. The aim of our study was to compare the short-term outcome and QOL of two perineal procedures in patients with rectal prolapse.

Methods

All patients with full-thickness rectal prolapse admitted to our institution and undergoing Delorme and Altemeier procedures from 2005 to 2013 were identified using an institutional, IRB-approved rectal prolapse database. Short-term outcomes and QOL were compared.

Results

Seventy-five patients (93 % female) underwent rectal prolapse surgery: 22 Altemeier and 53 Delorme, mean age 72 ± 15 years. Sixty-six percentage of patients were ASA grade III or IV (Table 1). The median hospital stay was longer in Altemeier’s group [4 (1–44) days vs. 3 (0–14) days; p = 0.01]. After a median follow-up of 13 (1–88) months, the rate of recurrent prolapse was 14 % (n = 11) [Altemeier 2 (9 %) vs. Delorme 9 (16 %) p = 0.071]. Postoperative complication rate was 12 % (n = 9) [Altemeier 5 (22 %) vs. Delorme 4 (7 %), p = 0.04]. There was no mortality. The Cleveland Global Quality of Life scores in each group were 0.6 ± 0.2 and 0.5 ± 0.3, respectively (p = 0.59), and were not changed by the surgery.
Table 1

Patient’s characteristics and procedures outcomes

 

Total (N = 75)

Altemeier’s (N = 22)

Delorme’s (N = 53)

p value

Age

 Mean (SD)

72 ± 15

75.3 ± 14.1

69.4 ± 15.4

0.14

Sex

 Female

70 (93 %)

21 (95 %)

49 (92 %)

0.99

ASA score

 1

1 (14 %)

0

1 (2 %)

0.54

 2

23 (33 %)

7 (33 %)

16 (33 %)

 3

42 (56 %)

11 (52 %)

31 (58 %)

 4

8 (11 %)

3 (14 %)

5 (9 %)

BMI

 Mean (SD)

24.3 ± 7.3

22.4 ± 10.8

25 ± 4.9

0.20

Intraoperative blood loss/ml, median

30 (10–300)

50 (10–200)

25 (10–300)

0.95

Postoperative stool frequency/per day, median

6 (1–40)

4 (1–40)

6 (3–10)

0.78

Pre-op FIQL

 Mean (SD)

7.5 ± 4.7

5.3 ± 4.1

7.9 ± 4.8

0.32

Post-op FIQL

 Mean (SD)

7.2 ± 5.2

5.9 ± 0.8

7.4 ± 5.6

0.72

Pre-op CSI

 Mean (SD)

34.4 ± 14.1

33.5 ± 10.8

34.6 ± 15.1

0.89

Post-op CSI

 Mean (SD)

31.3 ± 15.8

40.0 ± 17

29.9 ± 15.9

0.42

Pre-op CGQL

  Mean (SD)

0.5 ± 0.3

0.3 ± 0.3

0.5 ± 0.3

0.08

Post-op CGQL

 Mean (SD)

0.5 ± 0.3

0.6 ± 0.2

0.5 ± 0.3

0.59

ASA American Society of Anesthesiologists, BMI body mass index, FIQL fecal incontinence QOL, CSI Constipation Severity Index, CGQL Cleveland Global Quality of Life

Conclusions

In patients where abdominal repair of rectal prolapse is judged to be unwise, a Delorme procedure offers short-term control of the prolapse with low risk of complications and with reasonable function. In addition, patients that recur after a Delorme procedure can undergo another similar transanal procedure without compromising the vascular supply of the rectum.

Keywords

Rectal prolapse Delorme Altemeier Perineal repair 

Notes

Acknowledgments

Poster presentation at the annual meeting of the American Society of Colon and Rectal Surgeons, Hollywood, Florida, May 17–21, 2014.

Conflict of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Informed consent

A waiver of consent was obtained from the Institutional Review Board.

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Copyright information

© Springer-Verlag Italia Srl 2015

Authors and Affiliations

  • F. Elagili
    • 1
  • B. Gurland
    • 1
  • X. Liu
    • 1
  • J. Church
    • 1
  • G. Ozuner
    • 1
    Email author
  1. 1.Department of Colorectal Surgery, Digestive Disease InstituteCleveland ClinicClevelandUSA

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