Abstract
PURPOSE: A retrospective study was undertaken to assess the results of Delorme's procedure for rectal prolapse and to determine the advantages of an innovative extended transrectal repair, which aims at performing a total pelvic floor repair. METHODS: A total of 85 patients, ranging in age from 21 to 97 years, were operated on. Sixty-five (82 percent) patients had varying degrees of fecal incontinence. Similar groups of patients were compared with regard to control of the prolapse and restoration of continence according to 1) age and medical condition and 2) operative technique: original vs.extended operation. RESULTS: Twelve patients (14 percent) developed postoperative complications. There was one perioperative death (1.2 percent). Eighty patients were followed for 6 to 136 (median, 33) months. Eleven (13.5 percent) developed recurrent full-thickness prolapse. The recurrence rate was significantly different 1) between 44 elderly and poor operative risk patients not suitable for abdominal surgery (22.5 percent) and 41 younger patients without concurrent medical conditions, electively submitted to perineal repair (5 percent) (P <0.05), and 2) between the original procedure (21 percent of 44 patients) and the modified technique (5 percent of 41 patients) (P <0.05). Forty five patients (69 percent) improved or regained full continence. No patient worsened. No residual dysfunction was induced. Restoration of continence was not influenced by selection of patients or surgical technique. CONCLUSIONS: Despite increased morbidity (22 percent; P <0.05), advantages of the modified technique were 1) over the original procedure, a reduced recurrence rate, 2) over perineal proctectomy, the absence of coloanal anastomosis and better functional outcome, and 3) over abdominal rectopexy, a less aggressive approach without disturbing effects on bowel habits.
Similar content being viewed by others
References
Lechaux JP, Johann M. L'opération de Delorme dans le traitement du prolapsus rectal. Presse Méd 1984;13:219–20.
Lechaux JP. Traitement chirurgical du prolapsus rectal complet de l'adulte-Edition techniques-Encycl. Méd. Chir. (Paris-France), Techniques Chirurgicales-Généralités-Appareil Digestif, 40710, 1992:14.
Rogers J, Jeffery PJ. Post anal repair and intersphincteric Ivalon sponge rectopexy for the treatment of rectal prolapse. Br J Surg 1987;74:384–6.
Uhlig BE, Sullivan ES. The modified Delorme operation: its place in surgical treatment for massive rectal prolapse. Dis Colon Rectum 1979;22:513–21.
Watts JD, Rothenberger DA, Goldberg SM. Rectal prolapse: treatment. In: Henry MM, Swash M, eds. Coloproctology and the pelvic floor: pathophysiology and management. London: Butterworths, 1985:308–39.
Williams JG, Wong WD, Jensen L, Rothenberger DA, Goldberg SM. Incontinence and rectal prolapse: a prospective manometric study. Dis Colon Rectum 1991;34:209–16.
Holmström B, Brodén G, Dolk A. Results of the Ripstein operation in the treatment of rectal prolapse and internal rectal procidentia. Dis Colon Rectum 1986;29:845–8.
Allen-Mersh TG, Turner MJ, Mann CV. Effect of abdominal Ivalon® rectopexy on bowel habit and rectal wall. Dis Colon Rectum 1990;33:550–3.
Mann VC, Hofman C. Complete rectal prolapse: the anatomical and functional results of treatment by an extended abdominal rectopexy. Br J Surg 1988;75:34–7.
Speakman CT, Madden MV, Nicholls RJ, Kamm MA. Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study. Br J Surg 1991;78:1431–3.
Delemarre JB, Gooszen HG, Kruyt RH,et al. The effect of posterior rectopexy on fecal continence. Dis Colon Rectum 1991;34:311–6.
Sainio AP, Voutilainen PE, Husa AI. Recovery of anal sphincter function following transabdominal repair of rectal prolapse: cause of improved continence? Dis Colon Rectum 1991;34:816–21.
Schlinkert RT, Beart RW, Wolff BG, Pemberton JH. Anterior resection for complete rectal prolapse. Dis Colon Rectum 1985;28:409–12.
Watts JD, Rothenberger DA, Buls JG, Goldberg SM, Nivatvongs S. The management of procidentia: 30 years experience. Dis Colon Rectum 1985;28:96–102.
Mc Kee RF, Lauder JC, Poon FW, Aitchison MA, Finlay IG. A prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gynecol Obstet 1992;174:145–8.
Sayfan J, Pinho M, Alexander-Williams J, Keighley MR. Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex® rectopexy for rectal prolapse. Br J Surg 1990;77:143–5.
Williams JG, Rothenberger DA, Madoff RD, Goldberg SM. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum 1992;35:830–4.
Ramanujam PS, Venkatesh KS. Perineal excision of rectal prolapse with posterior levator ani repair in elderly high risk patients. Dis Colon Rectum 1988;31:704–6.
Prasad ML, Pearl RK, Abcarian H,et al. Perineal proctectomy, posterior rectopexy, and post anal levator repair for the treatment of rectal prolapse. Dis Colon Rectum 1986;29:547–52.
Author information
Authors and Affiliations
About this article
Cite this article
Lechaux, J.P., Lechaux, D. & Perez, M. Results of Delorme's procedure for rectal prolapse. Dis Colon Rectum 38, 301–307 (1995). https://doi.org/10.1007/BF02055608
Issue Date:
DOI: https://doi.org/10.1007/BF02055608