Delorme's procedure for rectal prolapse: clinical and physiological analysis.

Abstract

Clinical and physiological results of Delorme's procedure were assessed retrospectively in patients undergoing this procedure for rectal prolapse. A consecutive series of 31 patients (7 males, 24 females; age, 14-93, mean 70 years) with full-thickness, rectal prolapse were treated by Delorme's procedure between 1994 and 2002. Median follow-up was 39 (range, 6-96) months. Good results were achieved in 27 patients (87 percent), prolapse recurrence was observed in 4 (13 percent), and mean recurrence time was 14 (range, 3-25) months. There were no postoperative deaths. Minor complications occurred in four patients. The median changes in preoperative and postoperative physiologic patterns in 16 patients were as follows: resting pressure from 21.0 (range, 5-48) to 23.5 (range, 12-76) cm H2O (P = 0.030), squeeze pressure from 64.0 (range, 27-248) to 108.0 (range, 32-264) cm H2O (P = 0.041), volume at first sensation from 100 (range, 70-180) to 70 (range, 40-130) ml (P = 0.002), maximum tolerated volume from 260 (range, 120-400) to 160 (range, 70-400) ml (P = 0.001). Incontinence improved in 63 percent. No patient became constipated, and 38 percent of those constipated preoperatively improved. The preoperative incontinence score improved from 11.5 (range, 1-20) to 6.0 (range, 0-20) after operation (P < 0.0001). Delorme's procedure had a low morbidity, did not lead to constipation, improved anal continence, and had a reasonably low recurrence rate. Improved anal sphincter and rectal sensation were associated with a reduced incidence of defecatory problems after Delorme's procedure.