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      Delorme's Procedure for Complete Rectal Prolapse: Does It Still Have It's Own Role?

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          Abstract

          Purpose

          Although there are more than a hundred techniques, including the transabdominal and the perineal approaches, for the repair of the rectal prolapsed, none of them is perfect. The best repair should be chosen not only to correct the prolapse but also to restore defecatory function and to improve fecal incontinence throughout the patient's lifetime. The aim of this retrospective review is to evaluate clinical outcomes of the Delorme's procedure for the management of the complete rectal prolapse.

          Methods

          A total of 19 patients (13 females and 6 males) with complete rectal prolapses were treated by using the Delorme's procedure in St. Vincent's Hospital, The Catholic University of Korea, from February 1997 to February 2007. Postoperative anal incontinence was evaluated using the Cleveland Clinic Incontinence Score.

          Results

          All 19 patients had incontinence to liquid stool, solid stool, and/or flatus preoperatively. Three (15.8%) patients reported recurrence of the rectal prolapse (at 6, 18, 29 months, respectively, after the operation). Information on postoperative incontinence was available for 16 of the 19 patients. Twelve of the 16 patients (75%) reported improved continence (5 [31.3%] were improved and 7 [43.7%] completely recovered from incontinence) while 4 patients had unchanged incontinence symptoms. One (6.3%) patient who did not have constipation preoperatively developed constipation after the operation.

          Conclusion

          The Delorme's procedure is associated with a marked improvement in anal continence, relatively low recurrence rates, and low incidence of postoperative constipation. This allows us to conclude that this procedure still has its own role in selected patients.

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          Most cited references26

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          Complete rectal prolapse: evolution of management and results.

          Tony Goldberg, Scott Wong, Wun-Jae Kim … (1999)
          Optional treatment for complete rectal prolapse remains controversial. We reviewed our experience over a 19-year period to assess trends in choice of operation, recurrence rates, and functional results. We identified 372 patients who underwent surgery for complete rectal prolapse between 1976 and 1994. Charts were reviewed and follow-up (median, 64: range, 12-231 months) was obtained by mailed questionnaire (149 patients; 40 percent) and telephone interview (35 patients; 9 percent). Functional results were obtained from 184 responders (49 percent). Median age of patients was 64 (11-100) years, and females outnumbered males by nine to one. One-hundred and eighty-eight patients (51 percent) were lost to follow-up; 183 patients (49 percent) underwent perineal rectosigmoidectomy, and 161 patients (43 percent) underwent abdominal rectopexy with bowel resection. The percentage of patients who underwent perineal rectosigmoidectomy increased from 22 percent in the first five years of the study to 79 percent in the most recent five years. Patients undergoing perineal rectosigmoidectomy were more likely to have associated medical problems as compared with patients undergoing abdominal rectopexy (61 vs. 30 percent, P = 0.00001). There was no significant difference in morbidity, with 14 percent for perineal rectosigmoidectomy vs. 20 percent for abdominal rectopexy. Abdominal procedures were associated with a longer length of stay as compared with perineal rectosigmoidectomy (8 vs. 5 days, P = 0.001). Perineal procedures, however, had a higher recurrence rate (16 vs. 5 percent, P = 0.002). Functional improvement was not significantly different, and most patients were satisfied with treatment and outcome. We conclude that abdominal rectopexy with bowel resection is associated with low recurrence rates. Perineal rectosigmoidectomy provides lower morbidity and shorter length of stay, but recurrence rates are much higher. Despite this, perineal rectosigmoidectomy has appeal as a lesser procedure for elderly patients or those patients in the high surgical risk category. For younger patients, the benefits of perineal rectosigmoidectomy being a lesser procedure must be weighed against a higher recurrence rate.Patient satisfaction]
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            Nineteen years' experience with the one-stage perineal repair of rectal prolapse.

            C Schowengerdt, Jamie Hunt, William Altemeier … (1971)
            Article 0 comments Cited 20 times – based on 0 reviews     Review now
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              Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse.

              Norman Billingham, Charles Grant, M Keighley … (1994)
              A randomized trial was performed to compare abdominal resection rectopexy and pelvic floor repair (n = 10) with perineal rectosigmoidectomy and pelvic floor repair (n = 10) in elderly female patients with full-thickness rectal prolapse and faecal incontinence. There were no recurrences of full-thickness prolapse following resection rectopexy but one after rectosigmoidectomy. Continence to liquid and solid stool was achieved in nine patients, with faecal soiling reported in only two, after resection rectopexy and in eight, with soiling in six, following rectosigmoidectomy. The median (range) frequency of defaecation was only 1 (1-3) per day following resection rectopexy compared with 3 (1-6) per day after rectosigmoidectomy. There was an increase in the mean(s.d.) maximum resting pressure after resection rectopexy (19.3(15.28) cmH2O) compared with a reduction following rectosigmoidectomy (-3.4(13.75) cmH2O) (P = 0.003). Mean(s.d.) compliance was also greater after resection rectopexy than following rectosigmoidectomy (3.9(0.75) versus 2.2(0.78) ml/cmH2O, P < 0.001). Abdominal resection rectopexy gives better functional and physiological results than perineal rectosigmoidectomy.
              Article 0 comments Cited 16 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Korean Soc Coloproctol
                Journal ID (publisher-id): JKSC
                Title: Journal of the Korean Society of Coloproctology
                Publisher: The Korean Society of Coloproctology
                ISSN (Print): 2093-7822
                ISSN (Electronic): 2093-7830
                Publication date (Print): February 2012
                Publication date (Electronic): 29 February 2012
                Volume: 28
                Issue: 1
                Pages: 13-18
                Affiliations
                Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
                [1 ]Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
                Author notes
                Correspondence to: Hyeon-Min Cho, M.D. Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 442-723, Korea. Tel: +82-31-249-7084, Fax: +82-31-247-5347, hmcho@ 123456catholic.ac.kr
                Article
                DOI: 10.3393/jksc.2012.28.1.13
                PMC ID: 3296936
                PubMed ID: 22413077
                SO-VID: c72d5aa1-2810-4e45-adc1-158d2e8907d2
                Copyright © © 2012 The Korean Society of Coloproctology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 May 2011
                Date revision received : 18 October 2011
                Date accepted : 20 December 2011
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Internal medicine
                Keywords: rectal prolapse,incontinence,delorme's procedure
                Data availability:
                ScienceOpen disciplines: Internal medicine
                Keywords: rectal prolapse, incontinence, delorme's procedure

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