This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pelvic floor repair does not seem to influence invagination as a pathogenic mechanism. Surgery puts the rectum back in place. There are other methods to repair an external rectal prolapse and the surgeon will discuss these with you. Although constipation improved in most patients as evidenced by a lower Wexner score, patients with persistent constipation are at a higher risk of early recurrence. According to the univariate analysis, constipation and concomitant pelvic floor repair were the only factors found to be associated with recurrence. On the other hand, anterior and posterior repair of the pelvic floor should be systematically performed in all women requiring surgery for rectal prolapse in order to reduce recurrence rates in these patients. What is the next good option?”, A. Senapati, R. G. Gray, L. J. Middleton et al., “PROSPER: a randomised comparison of surgical treatments for rectal prolapse,”, M. T. Young, M. D. Jafari, M. J. Phelan et al., “Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era?”. Fourteen women (46.6%) had undergone a hysterectomy and eight (26.6%) had some level of associated genital prolapse. With respect to anal incontinence, no significant improvements were observed after the completion of the procedure Delorme. This study demonstrates that Delorme’s operation is a safe procedure with very low mortality (0% in our series), a 9.5% morbidity, and an acceptable overall recurrence of 12% after a long median follow-up of seven years. Patient’s baseline characteristics, postoperative complications, or recurrences were recorded. Advertising on our site helps support our mission. Probability of no recurrence after Delorme procedure (Global series). The median follow-up was 85 months (IQR 28 to 132). This operation involves the surgeon remov- ing some of the prolapsed lining of the rectum (mucosa) and reinforcing the muscle of the rectum by placating stitches. Incontinence and constipation were reassessed using a defecatory diary and Jorge and Wexner score [9]. In our opinion, age or surgical risk should not discourage an abdominal approach. It is considered that abdominal procedures carry a lower rate of recurrence and better functional outcomes but may entail an undesirable risk in young patients: fertility disorders in women and sexual function in men. Although differences were not statistically significant probably due to the small sample size, these results are consistent with those reported in the literature [8, 12, 13]. No procedure is considered the best overall. The lining of the rectum is removed and the muscular layer folded to shorten the rectum. To avoid the protrusion of the apex of prolapses repaired by Delorme’s procedure, Williams et al. This is of special note since the recurrence rates reported in the literature are 47% lower as compared to those reported in an independent review [10]. Advertising on our site helps support our mission. Mayo Clinic, Rochester, Minn. Aug. 9, 2013. Rectal prolapse occurs when the rectum becomes stretched out and protrudes from the anus. Rectal prolapse. Carlos Placer, Jose M. Enriquez-Navascués, Ander Timoteo, Garazi Elorza, Nerea Borda, Lander Gallego, Yolanda Saralegui, "Delorme’s Procedure for Complete Rectal Prolapse: A Study of Recurrence Patterns in the Long Term", Surgery Research and Practice, vol. Comparison of probability of no recurrence with time for patients according to constipation (Kaplan-Meier method). Rectal procedures are often used in older patients and in patients who have more medical problems. It is usually performed under general anesthesia and is the approach most often used in healthy adults. It appears to be slightly more common in people who have the perineal procedure compared with an abdominal one. However, myorrhaphy and elevation of levator ani muscles may delay or prevent the formation of a new peritoneocele and hinder the descent of the longitudinal plication in Delorme’s procedure. Your doctor is likely to recommend drinking lots of fluids, using stool softeners and eating a fiber-rich diet in the weeks after surgery to avoid constipation and excessive straining that can lead to recurrence of the rectal prolapse. Results. © 1998-2020 Mayo Foundation for Medical Education and Research (MFMER). American Society of Colon & Rectal Surgeons. Although there is a range of ongoing randomized clinical trials (e.g., DeLoRes, Deliver, and Danish trial) whose results have not been published yet, at present there is not strong evidence of the superiority of a treatment over the others [5, 6]. Neither de novo incontinence nor de novo constipation was observed during the follow-up. The primary outcome was recurrence. Recurrence was not observed in any of the seven women who underwent concomitant posterior or total levatorplasty (7/30). Which approach your surgeon uses depends on a number of factors, such as your age, your other health problems, your surgeon's experience and preferences, and equipment available. Mayo Clinic does not endorse companies or products. As many as 29 patients (69.1%) had an ASA score III and 13 had an ASA score II (30.9%). The two most common rectal approaches are the Altemeier and Delorme procedures: As with any surgery, anesthesia complications, bleeding and infection are always risks. A meta-analysis of individual patient data,”, A. M. I. Watts and M. R. Thompson, “Evaluation of Delorme's procedure as a treatment for full-thickness rectal prolapse,”, B. P. Watkins, J. Landercasper, G. E. Belzer et al., “Long-term follow-up of the modified Delorme procedure for rectal prolapse,”, A. H. ElGadaa, N. Hamrah, and Y. AlAshry, “Complete rectal prolapse in adults: clinical and functional results of Delorme procedure combined with postanal repair,”, M. Youssef, W. Thabet, A. El Nakeeb et al., “Comparative study between Delorme operation with or without postanal repair and levateroplasty in treatment of complete rectal prolapse,”, N. S. Williams, P. Giordano, L. S. Dvorkin, A. Huang, F. H. Hetzer, and S. M. Scott, “External pelvic rectal suspension (the express procedure) for full-thickness rectal prolapse: evolution of a new technique,”, S. W. Chun, A. J. Pikarsky, S. Y. Variability of recurrence rates may be due to different size of the prolapses, associated pelvic disorders, follow-up periods, reinterventions, constipation, and case-mix [11, 12]. The objective of this study was to determine the recurrence rate and associated risk factors of full-thickness rectal prolapse in the long term after Delorme’s procedure.Patients and Methods. D'Hoore, R. Cadoni, and F. Penninckx, “Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse,”, S. R. Brown, “The evidence base for rectal prolapse surgery: is resection rectopexy worth the risk?”, S. Lee, B.-H. Kye, H.-J. According to the univariate analysis, constipation and concomitant pelvic floor repair were the only factors found to be associated with recurrence, the former increasing the risk for recurrence and the latter reducing it. Actuarial recurrence at five years was 9.9%. Functional outcomes of Delorme’s procedure. We are committed to sharing findings related to COVID-19 as quickly as possible. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Categorical variables were analyzed using either Chi-squared test or Fisher’s test, as appropriate. In some cases of very minor, early prolapse, treatment can begin at home with the use of stool softeners and by pushing the fallen tissue back up into the anus by hand. You'll spend a brief time in the hospital recovering and regaining your bowel function. However, surgery is usually necessary to repair the prolapse. 9500 Euclid Avenue, Cleveland, Ohio 44195 |. This site complies with the HONcode standard for trustworthy health information: verify here. Delorme’s Procedure This is an operation that is performed on the back passage to repair an external rectal prolapse. Surgery was performed as described in the literature [7, 8]. American Society of Colon and Rectal Surgeons. Urinary retention (inability to pass urine). The urinary catheter was removed within the first day when the patient had no previous prostate disorders. Copyright © 2015 Carlos Placer et al. A urinary catheter was inserted. It is a procedure to repair a rectal prolapse. A Delorme’s procedure aims to repair the prolapse. Delorme’s procedure improves constipation, as it reduces compliance and improves rectal sensation [18, 19]. Quantitative variables were analyzed by Mann-Whitney test. Recurrence of rectal prolapse after surgery occurs in about 2 to 5 percent of people. On the other hand, the main strengths of this study are the long follow-up period, with a median follow-up above seven years, and the low levels of censored data during the study period. This repair is typically reserved for those who are not candidates for open or laparoscopic repair. Two patients had undergone surgery for prolapse previously (a posterior rectopexy and a Frykman-Goldberg procedure). Review articles are excluded from this waiver policy. Young males undergoing surgery for rectal prolapse should be informed that abdominal surgery might cause pelvic nerve damage. What is a rectal prolapse? For most people, rectal prolapse surgery relieves symptoms and improves fecal incontinence and constipation. Surgery was performed either under general or spinal hyperbaric anaesthesia in the lithotomy position. Rectopexy can also be performed laparoscopically through small keyhole incisions, or robotically, making recovery much easier for patients. Spinal anesthesia or an epidural (anesthesia that blocks pain in a certain part of the body) may be used instead of general anesthesia in these patients. Accessed March 15, 2016. Risks vary, depending on surgical technique. See our safe care and visitor guidelines, plus trusted coronavirus information. Last reviewed by a Cleveland Clinic medical professional on 05/07/2018. The amount of time you spend in the hospital, possibly just overnight, will depend on which procedure you have. Patients with severe constipation are not ideal candidates for this technique unless abdominal surgery is not indicated for particular reasons. Conclusions. The same conclusions can be drawn from other series treated with modified Altemeier’s procedure combined with levatorplasty, although this technique can also avoid the “cul-de-sac of Douglas as a pathogenic factor” [16]. Discuss your options with your surgeon. designed the so-called express procedure by which rectal suspension is achieved using collagen strips [15]. However, perineal procedures are still performed in high-risk patients or in case of recurrence following abdominal surgery. It should be elucidated if the modification of these pathogenic factors through perineal surgery may have an influence on long-term outcomes. Joyce MR, Hull TL. 2015, Article ID 920154, 6 pages, 2015. https://doi.org/10.1155/2015/920154, 1Department of Colorectal Surgery, Division of General and Gastrointestinal Surgery, Donostia University Hospital, 20014 San Sebastián, Spain. Semin Colon Rectal Surg March 2010 21:37-44.

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