Delorme Group Research Articles

FTP2.3 A Systematic Review and Meta-Analysis Comparing Outcomes of the Common Perineal Procedures for Rectal Prolapse -Delorme Vs Altemeir

Abstract Introduction There is no consensus yet as to the best surgical option for treatment of rectal prolapse. In this systematic review and meta-analysis we compared the outcomes for the two most commonly employed perineal operations for rectal prolapse – Delorme’s and Altemeier’s procedure. Methods A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme’s and Altemeier’s procedures were extracted. Primary outcomes included total operative time, anastomotic leak rate, post-operative wound infections and length of hospital stay. The analysed secondary outcomes were operation time, volume of blood loss and length of hospital stay. Revman 5.3 was used to perform statistical analysis. Results 10 studies including a total of 605 patients were selected; 286 patients had Altemeier procedure, 39 patients had Altemeier and Plasty (perineoplasty or levatoroplasty) whilst 280 patients had Delorme procedure. Recurrence was found to be significantly lower in the Altemeier group compared to the Delorme group (OR: 0.66; 95% CI [0.44 – 0.99], P= 0.05). Anastomotic leak was found to be significantly less in the Altemeier group than in the Delorme group (RD: 0.05; 95% CI [0.00 – 0.09], P= 0.03). Hospital stay was significantly more after Altemeiers procedure than after Delorme procedure (MD: 3.05, 95% CI [0.95 – 5.51], p=0.004). No significant difference was found with respect to operative time, Intra operative blood loss and mortality rates. Conclusion Our study indicates that between the two common perineal procedures, Altemeier’s operation has better outcomes. Future high quality RCTs with long follow up are required to corroborate these findings.

O140 Delorme vs. Altemeier: a systematic review and meta-analysis comparing the common perineal procedures for rectal prolapse

Abstract Introduction Rectal prolapse is a particularly distressing condition for patients, and there is no consensus yet as to the best surgical option for treatment. In this systematic review and meta-analysis we compared the outcomes for the two most commonly employed perineal operations for rectal prolapse – Delorme's and Altemeier's procedure. Methods A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme's and Altemeier's procedures were extracted. Primary outcomes included recurrence rate, anastomotic leak rate, and length of hospital stay. The secondary outcomes were operation time, volume of blood loss and length of hospital stay. Revman 5.3 was used to perform statistical analysis. Results 10 studies including a total of 605 patients were selected. Recurrence (OR: 0.66; 95% CI [0.44–0.99], P= 0.05) and anastomotic leak (RD: 0.05; 95% CI [0.00–0.09], P= 0.03) were found to be significantly less in the Altemeier group than in the Delorme group. However on subgroup analysis Altemeiers with plasty (perineoplasty or levatoroplasty) failed to show significant differences in comparison to Delorme's. Hospital stay was significantly more after Altemeiers procedure than after Delorme procedure (MD: 3.05, 95% CI [0.95–5.51], p=0.004). No significant difference was found with respect to operative time, intra operative blood loss and mortality rates. Conclusion Our study indicates that between the two common perineal procedures, Altemeier's operation has better outcomes. Future high quality RCTs with long follow up are required to corroborate these findings.

AN EVALUATION OF CLINICAL OUTCOMES AFTER ABDOMINAL MESH RECTOPEXY & DELORME'S PROCEDURE FOR RECTAL PROLAPSE AT TERTIARY HEALTH CARE CENTER

Background: Rectal prolapse is protrusion of rectum through anal canal, and proccidentia ~ complete prolapse is the term used when full thickness rectal wall prolapse . 30 patients presenting with Materials and methods: mass per rectum were evaluated & diagnosed clinically as having rectal prolapse were included in the study. The recurrence rate for the abdominal mesh Results: rectopexy is considered to be lower than Perineal Delorme's procedure. There was no recurrence in the rectopexy group. There was 1 recurrence (10%) in Delorme's group. .Better outcomes achieved when treatment individualized to Conclusion: each patient. Abdominal rectopexy for patients who can tolerate laparotomy & signicant constipation. .Delorme's considered in young patients with short prolapse but with acceptable recurrence rate.

Efficacy analysis of Altemeier and Delorme procedures for the rectal prolapse

Objective: To evaluate the quality of life after Altemeier and Delorme procedures for rectal prolapse patients. Methods: A retrospective cohort study was performed. Clinical data of patients with full-thickness rectal prolapse undergoing surgical treatment in the Sixth Affiliated Hospital, Sun Yat-sen University from February 2013 to January 2018 were retrospectively analyzed. Patients who had no preoperative imaging data, who suffered from internal rectal intussusception, or who did not undergo Altemeier and Delorme operations were excluded. Sixty-seven patients were enrolled, including 32 males with median age of 20.5 (13, 34) years and 35 females with median age of 65.0 (50, 77) years. According to different procedures, patients were divided into the Altemeier group (48 cases) and the Delorme group (19 cases), who received standard Altemeier and Delorme operations respectively. The maximal prolapse length of preoperative squat position, the Longo constipation score, Wexner incontinence score, EQ-5D-5L score, postoperative complications and recurrence rate were analyzed and compared between two groups. Results: The maximal prolapse length of preoperative squat position in Altemeier group and Delorme group was (7.3±3.3) cm and (4.9±2.1) cm respectively with significant difference (t=2.907, P=0.005). The operations in both groups were successfully completed. The operation time and postoperative hospital stay of Altemeier group were longer than those of Delorme group [(112.3±47.0) minutes vs. (80.7±35.4) minutes, t=2.637, P=0.010; (11.3±5.0) days vs. (8.6±3.0) days, t=2.177, P=0.033]. The median follow-up period was 26 (13, 45) months. In the last follow-up, compared to pre-operation, the Longo constipation score [9.0 (6.0, 14.0) vs 4.0 (1.0, 6.5), Z=-4.989, P<0.001], Wexner incontinence score [0 (0, 5.5) vs. 0 (0, 2.0), Z=-3.325, P<0.001] and EQ-5D-5L score [45.0 (40.0, 57.5) vs. 80.0 (70.0, 87.5), Z=-5.587, P<0.001] were all improved obviously in the Altemeier group, meanwhile Longo constipation score [6.0 (5.0, 14.0) vs. 3.0 (1.0, 7.0), Z=-2.186, P=0.029], Wexner incontinence score [0 (0, 12.0) vs. 0 (0, 4.0), Z=-2.325, P=0.020] and EQ-5D-5L score [50.0 (35.0, 60.0) vs. 75.0 (65.0, 90.0), Z=-3.360, P=0.001] in the Delorme group were all improved obviously as well. The postoperative morbidity of complication between the two groups was not significantly different [10/48 (20.8%) vs. 4/19 (21.1%), χ(2)=0.049, P=0.826]. Sixteen patients (28.0%) relapsed after operation, including 10 patients in the Altemeier group and 6 patients in the Delorme group, without statistically significant difference (P=0.134). Conclusions: Both the Altemeier and Delorme procedures are effective treatments for rectal prolapse, which can improve the postoperative quality of life. Delorme procedure has the advantages of shorter operation time and faster postoperative recovery in patients with mild prolapse.

Laparoscopic ventral mesh rectopexy vs Delorme's operation in management of complete rectal prolapse: a prospective randomized study.

Various surgical operations have been devised for the treatment of rectal prolapse, yet no ideal procedure has been described. The present study aims to compare the clinical and functional outcome of laparoscopic ventral mesh rectopexy (LVMR) and Delorme's operation for complete rectal prolapse. Fifty patients with complete rectal prolapse were enrolled in this study. Patients were randomly selected to undergo either LVMR or Delorme's procedure after clinical, manometric and radiological evaluation. Patient characteristics, operative data, postoperative complications, recurrence of rectal prolapse and continence state were evaluated. Patients were followed for a mean duration of 18months. Thirty-one (62%) patients were women and 19 (38%) patients were men with a mean age of 39.7±6.9years. Patients were allocated into two equal groups: LVMR group and Delorme's group. Thirty-three (66%) complained of faecal incontinence preoperatively. Patients were followed for 18months. There was no major postoperative complication or treatment death. Improvement in continence was reported in 80.9% of patients (83.3% in group 1 vs 71.4% in group 2). Recurrent prolapse was observed in 16% of patients in group 2 and 8% in group 1 (P=0.66). The operation time was significantly greater in group 1 and the length of stay greater in group 2. There was no difference in the fall of constipation score between the groups. There was no statistically significant difference in the incidence of recurrence of complete rectal prolapse or postoperative improvement of symptoms between the two groups. Hospital stay was longer after Delorme's procedure but the operation time was shorter. Neither procedure proved definite superiority regarding the clinical and functional outcome at 18months of follow-up.

Anterior Modification of Delorme Procedure Provides Equivalent Results to Delorme Procedure in Treatment of Rectal Outlet Obstruction

This study was designed to assess the results of the standard Delorme procedure versus an anterior modification of the Delorme procedure in the treatment of patients with rectal outlet obstruction secondary to internal intussusception with or without rectocele. A descriptive retrospective study from October 1997 to May 2001 was undertaken. Twenty-seven patients with symptoms of rectal outlet obstruction assumed to be caused by internal rectal prolapse or a combination of internal rectal prolapse and rectocele underwent surgical repair. Twenty-two patients had preoperative defecography and anal manometry. Thirteen patients had an anterior Delorme repair; 14 patients had a standard Delorme repair. Selection of procedure was chronologic with the standard Delorme undertaken in the earlier group. Preoperative and operative data were collected retrospectively. Twenty-seven women, aged 29 to 94 (mean, 62.0 for anterior Delorme, 66.3 for Delorme) years were followed up for the duration of the study (mean follow-up, 15.9 months for anterior Delorme and 32.1 months for Delorme). Twelve patients (92.3%) reported a good to excellent overall result after the anterior Delorme procedure versus 14 patients (100%) in the Delorme group. Symptomatic improvement was observed in 85.7% of patients who had incomplete evacuation in the anterior Delorme group versus 90.9% in the Delorme group. Symptoms of constipation, bleeding, and the need to manually assist in defecation by pushing in the perineum or vagina improved in 100% of patients in both groups. Discontinuation of laxative use after the procedure was reported by 75% of patients in the anterior Delorme group versus 100% in the Delorme group. Eight patients experienced minor complications, 4 of these being urinary retention. In the postoperative period, no patients in the modified group experienced incontinence. Sixty three percent of the Delorme group experienced some sort of incontinence within the first 2 to 3 months (p = 0.038). An anterior modification of the Delorme procedure, which requires less operative dissection, can be performed with results nearly equivalent to those of the established Delorme procedure in the treatment of rectal outlet obstruction secondary to internal intussusception with or without rectocele.

Long-Term Results of Delorme's Procedure and Orr-Loygue Rectopexy to Treat Complete Rectal Prolapse

The aim of this study was to assess long-term outcome of Orr-Loygue rectopexy and Delorme's procedures in total rectal prolapse management. Data were collected retrospectively from 1978 to 2001. Statistical analysis was performed by chi-squared test and Student's t -test. One hundred nine patients underwent either a Orr-Loygue rectopexy (49 patients) or a Delorme's procedure (60 patients). Mean follow-up was 88 (range, 1-300) months. In the rectopexy group, the overall complication rate and the recurrence rate were 33 percent and 4 percent, respectively. In patients with preoperative constipation, this symptom was improved or completely resolved in 33 percent and worsened in 58 percent postoperatively. Seventy-three percent of patients with preoperative incontinence were continent or had continence improvement postoperatively. In Delorme's group, overall complication and recurrence rates were 15 percent and 23 percent, respectively. Mortality was 7 percent. In patients with preoperative constipation, this symptom was improved or completely resolved in 54 percent and worsened in 12.5 percent of patients postoperatively. Forty-two percent of patients with preoperative incontinence were continent or had continence improvement postoperatively. In this study, Orr-Loygue rectopexy had a lower long-term recurrence rate. However, this surgical procedure is associated with a higher complication rate. We believe that Delorme's procedure is still a valuable option in selected patients with postoperative minimal morbidity but higher recurrence rate.

Microbilobata, a new genus of earliest terebratulid brachiopod from the lower Silurian of Northwestern Canada: Implications for the origin of higher taxa

Microbilobata avalanchensis n. gen. and n. sp. from the Lower Silurian (upper Wenlock) carbonate rocks of the lower Delorme Group in the Avalanche Lake area, northwestern Canada, is described here as the earliest known terebratulid brachiopod. These small shells (less than 2 mm long) are subtriangular, anteriorly emarginate, possibly punctate, with both valves being sulcate at their anterior halves, the ventral sulcus bearing one prominent plica, and the dorsal sulcus marked by two plicae. Internally, M. avalanchensis has a centronelliform loop extending for about three fifths of the total shell length. The shells are silicified in carbonate rocks of mid to outer shelf origin. M. avalanchensis is relatively rare, with about 40 specimens so far found from samples collected at 58–60 m above the base of section AV5 in the Avalanche Lake area. Its presence in rocks of Wenlock age extends the earliest known terebratulids back about 16 million years from the oldest previously recorded terebratulids (earliest De...

New evidence for structure ofIrregulareaspididae tails from Lochkovian beds of the Delorme Group, Mackenzie Mountains, Northwest Territories, Canada

A hypocercal tail was thought by some to be characteristic of irregulareaspidid cyathaspidiform and of mostheterostracan agnathans. However, new specimens of Nahanniaspis mackenziei and Dinaspidella elizabethae from the Mackenzie Mountains, Canada, possess a nearly symmetrical forked caudal fin supported by lobes of dermal scales. These new irregulareaspidines provide additional evidence that heterostracan caudal fins are characterized by a forked, lobed shape and provide support for grouping fork-tailed thelodonts with heterostracans. Finally, possession of a forked caudal fin implies that irregulareaspidine tails created greater force and swimming efficiency than previously believed, allowing for a benthic or a nectonic existence.

A complete, articulated heterostracan from Wenlockian (Silurian) beds of the Delorme Group, Mackenzie Mountains, Northwest Territories, Canada

A new genus and species of heterostracan jawless vertebrate is described from early Wenlockian (Silurian) beds of the Delorme Group, Mackenzie Mountains, Northwest Territories, Canada. The age of t...

Lingulid brachiopods and Lingulichnus from a Silurian shelf–slope carbonate sequence, Delorme Group, Mackenzie Mountains, Northwest Territories

Structures assigned to the ichnogenus Lingulichnus, commonly containing the burrow-forming brachiopod, were collected from an argillaceous unit in a Silurian shelf dolostone sequence (Delorme Group). The sediments, benthic fauna, and inclined orientation of all lingulid burrows indicate the presence of a bottom current and restricted conditions on the margin of the Selwyn Basin. High-abundance–low-diversity faunas of lingulids and Lingulichnus are indicative of limiting conditions at the substrate surface. Under low-energy conditions, they seem to be indicative of the Zoophycos ichnofacies.