The modified Delorme operation: its place in surgical treatment for massive rectal prolapse.

Abstract

The modified Delorme operation represents an effective perineal approach for the treatment of massive rectal prolapse, giving low morbidity and mortality; it is especially suitable for the elderly, the infirm, and most poor-risk patients- and for the surgeon accustomed to an anorectal approach. Our modifications of the procedure include the following: operation in the prone-flexed position,in situ plication of the denuded muscular wall of the rectum above the levators, transrectal perineal repair, local infiltration of anesthetic with epinephrine, the use of polyglactin or polyglycolic suture, and preservation of the entire length of anal skin with a margin of rectal mucosa. Spincter plication where needed, together with excision of existing anal abnormalities and tailoring of the anal skin, improves the comfort, appearance, and ease of care in the area. In our series, 44 patients, women in a ratio of nearly ten to one, were operated on in a recent tenyear period. Ages ranged from 26 to 94 with an average age of 62 but predominance in the eighth decade. There have been no mortalities. Follow-up has been from two to ten years. Failure of surgery with recurrence of prolapse was found in three patients (7 per cent), and functional failure in one (2 per cent). Functional results were studied in 36 patients with satisfactory result in 35. Improved technique and criteria of patient selection has lowered the incidence of failure in the later years of study.