Delorme's procedure for complete rectal prolapse in severely debilitated patients. An analysis of 41 cases.
OBJECTIVE
This study was designed to assess the results of a minimally invasive surgical procedure for the correction of complete rectal prolapse in a poor surgical risk group.


METHODS
Over a ten-year period, 40 patients underwent 41 Delorme operations when advanced age and/or poor overall health mitigated against an abdominal approach. Mean age was 82 (range, 30-100) years. Eighty-eight percent were females. Surgery was performed in the prone jackknife position utilizing intravenous sedation and local anesthesia.


RESULTS
Follow-up ranges from 1 year to 2 years (mean, 47 months). There have been 9 recurrences in 8 patients (22 percent). Mean time to recurrence was 13 months (range, 1 month to 6 years). One death occurred in an 81-year-old patient within 24 hours of surgery from cardiopulmonary arrest. Minor complications occurred in 25 percent of patients.


CONCLUSIONS
Satisfactory prolapse repair was safely performed in 78 percent of this high-risk group. Pitfalls in performing this procedure relate primarily to associated perineal and colonic conditions. Most prominent among these conditions are weak or absent and sphincter tone, perineal descent, and previous sphincter injury. Extensive diverticular disease may prohibit effective and complete proximal mucosectomy. An inadequate mucosectomy sets the stage for early recurrence of prolapse.
Oliver
G C
GC
Division of Colon and Rectal Surgery, Robert Wood Johnson Medical School, Muhlenberg Regional Medical Center, Plainfield, New Jersey.
Vachon
D
D
Eisenstat
T E
TE
Rubin
R J
RJ
Salvati
E P
EP
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D012005:Rectal Prolapse / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000379:methods; D016896:Treatment Outcome