What operation for recurrent rectal prolapse after previous Delorme's procedure? A practical reality

Area of Science:

• Colorectal Surgery
• Surgical Gastroenterology

Background:

• Rectal prolapse is a condition requiring surgical intervention.
• Delorme's procedure is a perineal approach for rectal prolapse repair.

Purpose of the Study:

• To evaluate the efficacy and outcomes of Delorme's procedure for rectal prolapse.
• To analyze the recurrence rates and management strategies for rectal prolapse following Delorme's procedure.

Main Methods:

• Retrospective review of 40 patients who underwent Delorme's procedure between 2003 and 2014.
• Data collected included patient demographics, prolapse characteristics, operative details, complications, and recurrence data.
• Statistical analysis included Fisher exact test for comparing recurrence rates.

Main Results:

• The overall recurrence rate was 28%, with higher rates in emergency presentations (75%) versus elective (20.5%).
• Median follow-up was 6.5 months, with recurrence occurring at a median of 16 months post-surgery.
• Management of recurrent prolapse varied, including repeat Delorme's, Altemeier's procedure, or rectopexy with fecal diversion.

Conclusions:

• Delorme's procedure is a viable treatment for rectal prolapse, characterized by low morbidity and mortality.
• Recurrence management often involves pelvic approaches, influenced by patient factors.
• Early recurrence may indicate technical failure, potentially necessitating abdominal rectopexy with fecal diversion.