Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2016; 8(7): 508-512
Published online Jul 27, 2016. doi: 10.4240/wjgs.v8.i7.508
What operation for recurrent rectal prolapse after previous Delorme’s procedure? A practical reality
Muhammad A Javed, Faryal G Afridi, Dmitri Y Artioukh
Muhammad A Javed, Faryal G Afridi, Dmitri Y Artioukh, Southport and Ormskirk Hospital, Southport, Merseyside PR8 6PN, United Kingdom
Muhammad A Javed, Faryal G Afridi, Dmitri Y Artioukh, Renacres Hospital, Halsall, Nr Ormskirk, Lancashire L39 8SE, United Kingdom
Author contributions: Javed MA carried out the acquisition, analysis and interpretation of data and writing the manuscript; Afridi FG contributed to the initial acquisition and analysis of data; Artioukh DY carried out treatment of all patients, study conception and design, acquisition and interpretation of data, editing and final approval of the manuscript.
Institutional review board statement: This retrospective study was using previously collected hospital and operative data and did not require Ethics Committee approval.
Informed consent statement: The study did not require a specific consent apart from informed written consent obtained from each patient at the time of procedure.
Conflict-of-interest statement: There are no conflicts of interest.
Data sharing statement: The original anonymous dataset is available from the corresponding author at dmitri.artioukh@nhs.net. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mr Dmitri Y Artioukh, FRCS(Ed), MMedSci, FRCS(Gen Surg), Consultant Surgeon, Southport and Ormskirk Hospital, Town Lane, Southport, Merseyside PR8 6PN, United Kingdom. dmitri.artioukh@nhs.net
Telephone: +44-1704-704253 Fax: +44-1704-704518
Received: January 25, 2016
Peer-review started: January 25, 2016
First decision: March 25, 2016
Revised: April 9, 2016
Accepted: April 21, 2016
Article in press: April 22, 2016
Published online: July 27, 2016
Processing time: 168 Days and 13.3 Hours
Abstract

AIM: To report our experience with perineal repair (Delorme’s procedure) of rectal prolapse with particular focus on treatment of the recurrence.

METHODS: Clinical records of 40 patients who underwent Delorme’s procedure between 2003 and 2014 were reviewed to obtain the following data: Gender; duration of symptoms, length of prolapse, operation time, ASA grade, length of post-operative stay, procedure-related complications, development and treatment of recurrent prolapse. Analysis of post-operative complications, rate and time of recurrence and factors influencing the choice of the procedure for recurrent disease was conducted. Continuous variables were expressed as the median with interquartile range (IQR). Statistical analysis was carried out using the Fisher exact test.

RESULTS: Median age at the time of surgery was 76 years (IQR: 71-81.5) and there were 38 females and 2 males. The median duration of symptoms was 6 mo (IQR: 3.5-12) and majority of patients presented electively whereas four patients presented in the emergency department with irreducible rectal prolapse. The median length of prolapse was 5 cm (IQR: 5-7), median operative time was 100 min (IQR: 85-120) and median post-operative stay was 4 d (IQR: 3-6). Approximately 16% of the patients suffered minor complications such as - urinary retention, delayed defaecation and infected haematoma. One patient died constituting post-operative mortality of 2.5%. Median follow-up was 6.5 mo (IQR: 2.15-16). Overall recurrence rate was 28% (n = 12). Recurrence rate for patients undergoing an urgent Delorme’s procedure who presented as an emergency was higher (75.0%) compared to those treated electively (20.5%), P value 0.034. Median time interval from surgery to the development of recurrence was 16 mo (IQR: 5-30). There were three patients who developed an early recurrence, within two weeks of the initial procedure. The management of the recurrent prolapse was as follows: No further intervention (n = 1), repeat Delorme’s procedure (n = 3), Altemeier’s procedure (n = 5) and rectopexy with faecal diversion (n = 3). One patient was lost during follow up.

CONCLUSION: Delorme’s procedure is a suitable treatment for rectal prolapse due to low morbidity and mortality and acceptable rate of recurrence. The management of the recurrent rectal prolapse is often restricted to the pelvic approach by the same patient-related factors that influenced the choice of the initial operation, i.e., Delorme’s procedure. Early recurrence developing within days or weeks often represents a technical failure and may require abdominal rectopexy with faecal diversion.

Keywords: Rectal prolapse; Recurrence; Perineal repair; Delorme’s procedure

Core tip: Delorme’s procedure is an attractive and often the only treatment of rectal prolapse available to elderly individuals who often have no physiological reserves to withstand abdominal rectopexy. The management of the recurrent disease is frequently restricted to the perineal approach by the same patient-related factors that limited the choice of the initial operation. Early recurrence developing within days or weeks is difficult to treat and in sufficiently fit patients may require abdominal rectopexy combined with faecal diversion.