Anterior modification of Delorme procedure provides equivalent results to Delorme procedure in treatment of rectal outlet obstruction.
BACKGROUND
This study was designed to assess the results of the standard Delorme procedure versus an anterior modification of the Delorme procedure in the treatment of patients with rectal outlet obstruction secondary to internal intussusception with or without rectocele.


METHODS
A descriptive retrospective study from October 1997 to May 2001 was undertaken. Twenty-seven patients with symptoms of rectal outlet obstruction assumed to be caused by internal rectal prolapse or a combination of internal rectal prolapse and rectocele underwent surgical repair. Twenty-two patients had preoperative defecography and anal manometry. Thirteen patients had an anterior Delorme repair; 14 patients had a standard Delorme repair. Selection of procedure was chronologic with the standard Delorme undertaken in the earlier group. Preoperative and operative data were collected retrospectively.


RESULTS
Twenty-seven women, aged 29 to 94 (mean, 62.0 for anterior Delorme, 66.3 for Delorme) years were followed up for the duration of the study (mean follow-up, 15.9 months for anterior Delorme and 32.1 months for Delorme). Twelve patients (92.3%) reported a good to excellent overall result after the anterior Delorme procedure versus 14 patients (100%) in the Delorme group. Symptomatic improvement was observed in 85.7% of patients who had incomplete evacuation in the anterior Delorme group versus 90.9% in the Delorme group. Symptoms of constipation, bleeding, and the need to manually assist in defecation by pushing in the perineum or vagina improved in 100% of patients in both groups. Discontinuation of laxative use after the procedure was reported by 75% of patients in the anterior Delorme group versus 100% in the Delorme group. Eight patients experienced minor complications, 4 of these being urinary retention. In the postoperative period, no patients in the modified group experienced incontinence. Sixty three percent of the Delorme group experienced some sort of incontinence within the first 2 to 3 months (p = 0.038).


CONCLUSIONS
An anterior modification of the Delorme procedure, which requires less operative dissection, can be performed with results nearly equivalent to those of the established Delorme procedure in the treatment of rectal outlet obstruction secondary to internal intussusception with or without rectocele.
Dippolito
Anthony
A
Department of Surgery, St. Luke's Hospital & Health Network, Bethlehem, PA, USA.
Esser
Steven
S
Reed
James
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*