Outcome of the Delorme procedure for the management of complete rectal prolapse in children

Abstract

Objectives The aim of the study was to evaluate the surgical and functional outcome of the Delorme procedure for the management of full-thickness long-segment rectal prolapse (RP) in children. Patients and methods This study included 23 patients with a mean age of 5.5 ± 2 years. The severity of incontinence and impact on quality of life (QOL) were evaluated using the Fecal Incontinence Severity Index (FISI) and the Fecal Incontinence Quality of Life (FIQL) questionnaires. The primary outcome was defined as complete recovery of continence, and partial improvement was defined as improvement in either type or frequency of incontinence or both. Recurrence was defined as recurrent incontinence after complete recovery. The secondary outcome was defined as change in the impact of incontinence on patients' QOL as assessed by the FIQL questionnaire. Results The mean operative time was 60.7 ± 13 min, the mean time until the first oral intake was 8.7 ± 3.9 h, and the mean postoperative hospital stay was 33.4 ± 12 h. All patients showed significantly lower postoperative scores on individual items and the total FISI score. Surgical repair of RP showed a favorable outcome in the form of significantly higher postoperative scores of individual items of the FIQL questionnaire, with a significantly higher postoperative total FIQL score compared with preoperative scores. Throughout the follow-up duration of 25.6 ± 6.9 months, 18 patients (78.2%) showed complete recovery, four patients (17.4%) showed only partial improvement, and one patient (4.4%) developed recurrence of gas incontinence 6 months after the disappearance of his incontinence; however, in all five patients there was an infrequent occurrence of incontinence at a frequency of 1-3 times/month. Conclusion The Delorme procedure is safe and effective for the management of complete RP, with a high complete recovery rate and ability to alleviate the adverse impact of fecal incontinence on QOL even in those with partial improvement. The reported advantages and outcome of the Delorme procedure in children and adulthood could enable discarding old concepts for restricted indications for the procedure for old and/or unfit patients and could make it suitable for all cases with RP without limits of age or general condition.