Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier

Tech Coloproctol. 2015 Sep;19(9):521-5. doi: 10.1007/s10151-015-1337-y. Epub 2015 Jul 17.

Abstract

Purpose: Data comparing surgical outcomes and quality of life (QOL) following perineal repair of rectal prolapse are limited. The aim of our study was to compare the short-term outcome and QOL of two perineal procedures in patients with rectal prolapse.

Methods: All patients with full-thickness rectal prolapse admitted to our institution and undergoing Delorme and Altemeier procedures from 2005 to 2013 were identified using an institutional, IRB-approved rectal prolapse database. Short-term outcomes and QOL were compared.

Results: Seventy-five patients (93% female) underwent rectal prolapse surgery: 22 Altemeier and 53 Delorme, mean age 72 ± 15 years. Sixty-six percentage of patients were ASA grade III or IV (Table 1). The median hospital stay was longer in Altemeier’s group [4 (1–44) days vs. 3 (0–14) days; p = 0.01]. After a median follow-up of 13 (1–88) months, the rate of recurrent prolapse was 14% (n = 11) [Altemeier 2 (9%) vs. Delorme 9 (16%) p = 0.071]. Postoperative complication rate was 12% (n = 9) [Altemeier 5 (22%) vs. Delorme 4 (7%), p = 0.04]. There was no mortality. The Cleveland Global Quality of Life scores in each group were 0.6 ± 0.2 and 0.5 ± 0.3, respectively (p = 0.59), and were not changed by the surgery.

Conclusions: In patients where abdominal repair of rectal prolapse is judged to be unwise, a Delorme procedure offers short-term control of the prolapse with low risk of complications and with reasonable function. In addition, patients that recur after a Delorme procedure can undergo another similar transanal procedure without compromising the vascular supply of the rectum.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Digestive System Surgical Procedures / methods
  • Digestive System Surgical Procedures / statistics & numerical data
  • Female
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Perineum / surgery*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Quality of Life
  • Rectal Prolapse / surgery*
  • Rectum / surgery
  • Recurrence
  • Retrospective Studies
  • Transanal Endoscopic Surgery / methods*
  • Transanal Endoscopic Surgery / statistics & numerical data
  • Treatment Outcome