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PubMed1996

The Delorme procedure: a useful operation for complicated rectal prolapse in the elderly.

Full thickness rectal prolapse is a distressing and debilitating condition that often affects elderly patients. Fecal incontinence is usually present. Frequently, comorbid conditions or previous pelvic procedures complicate surgical care. A perineal approach may be used in these patients to avoid the complications of pelvic surgery and general anesthesia. The Delorme operation involves mucosal stripping and muscle plication of the rectal prolapse and is performed externally under regional or general anesthesia. We report our experience with this procedure in six elderly candidates who have undergone the Delorme procedure at the UCLA Center for Health Sciences in the past year. Two men and four women with a mean age of 78 +/- 12 years were followed over a mean of 11 +/- 4 months. Complicating factors included a mean of 1.7 failed prolapse operations per patient (0-6), pelvic radiation in two patients, and severe cardiac and pulmonary disease in two patients. Outpatient bowel preparations and same day admissions were used. Operative time averaged 80 minutes. No blood transfusions were required and postoperative stay averaged 2.7 days. A total of 67 per cent report improvement in continence. There was no major morbidity or mortality and only one recurrence. We conclude that the Delorme procedure is a safe and useful procedure for the treatment of complete rectal prolapse. Elderly patients, patients with failed prolapse operations, and those with prior pelvic surgery or radiation should be considered for this procedure.

Aged↗
PubMed1999

Sigmoid colon cancer presenting as complete rectal prolapse: report of a case.

We describe herein the unusual case of a 76-year-old woman who was diagnosed as having sigmoid colon cancer after presenting with complete rectal prolapse. The rectal prolapse was considered to have been caused by constipation accelerated by the colon cancer. The relationship between colorectal cancer and rectal prolapse has not yet been clarified; however, this case report suggests that rectal prolapse can present as a symptom of colorectal cancer. Thus, patients with a sudden onset of rectal prolapse should be screened for colorectal cancer.

Aged↗
PubMed1990

Rectal prolapse in infants and children.

Rectal prolapse that is intractable to the usual medical therapy was successfully managed without significant complications in 10 patients by simple subcutaneous encirclement of the anus with a heavy nonabsorbable suture, which was in place until the suture was removed or broke after 4 to 6 months. Four patients required two sutures and one needed a third insertion. Since this procedure is simple, has no serious complications, and controls rectal prolapse, it is recommended as the preferred initial surgical treatment of this condition.

Child↗
PubMed2000

Recurrent rectal prolapse: what is the next good option?

PURPOSE: The aim of this study was to assess the clinical and functional outcome of surgery for recurrent rectal prolapse and compare it with the outcome of patients who underwent primary operation for rectal prolapse. METHODS: All patients who underwent surgery for rectal prolapse were evaluated for age, gender, procedure, anorectal manometry and electromyography findings, and morbidity. The results for patients who underwent surgery for recurrent rectal prolapse were compared with a group of patients matched for age, gender, surgeon, and procedure who underwent primary operations for rectal prolapse. RESULTS: A total of 115 patients underwent surgery for rectal prolapse. Twenty-seven patients, 10 initially operated on at this institution and 17 operated on elsewhere, underwent surgery for recurrent rectal prolapse. These 27 patients were compared with 27 patients with primary rectal prolapse operated on in our department. In the recurrent rectal prolapse group, prior surgery included rectopexy in 7 patients, Delorme's procedure in 7 patients, perineal rectosigmoidectomy in 7 patients, anal encirclement procedure in 4 patients, and resection rectopexy in 2 patients. Operations performed for recurrence were perineal rectosigmoidectomy in 14 patients, resection rectopexy in 8 patients, rectopexy in 2 patients, pelvic floor repair in 2 patients, and Delorme's procedure in 1 patient. There were no statistically significant differences between the groups in preoperative incontinence score (recurrent rectal prolapse, 13.6 +/- 7.8 vs. rectal prolapse, 12.7 +/- 7.2; range, 0-20) or manometric or electromyography findings, and there were no significant differences in mortality (0 vs. 3.7 percent), mean hospital stay (5.4 +/- 2.5 vs. 6.9 +/- 2.8 days), anastomotic complications (anastomotic stricture (0 vs. 7.4 percent), anastomotic leak (3.7 vs. 3.7 percent) and wound infection (3.7 vs. 0 percent), postoperative incontinence score (2.8 +/- 4.8 vs. 1.5 +/- 2.7), or recurrence rate (14.8 vs. 11.1 percent) between the two groups at a mean follow-up of 23.9 (range, 6-68) and 22 (range, 5-55) months, respectively. The overall success rate for recurrent rectal prolapse was 85.2 percent. CONCLUSION: The outcome of surgery for rectal prolapse is similar in cases of primary or recurrent prolapse. The same surgical options are valid in both scenarios.

Adult↗
PubMed1999

Defecography: does parity play a role in the development of rectal prolapse?

Few studies related to parity address the changes in anorectal function in women. Since the majority of patients with rectal prolapse are women, we undertook this study to assess the role of parity in the development of rectal prolapse. We retrospectively reviewed defecography studies performed on 354 female patients over a 10-year period. Studies noting the presence of intra-anal and external rectal prolapse (full thickness protrusion of the rectum into and through the anal sphincter) were reviewed. Cases with intrarectal or hidden rectal prolapse, a condition of lesser clinical importance, were excluded. The obstetric histories of the patients with rectal prolapse (n = 27) were compared to those of patients without rectal prolapse (n = 88). There was a larger proportion of nulliparous women in the rectal prolapse group than in the group without rectal prolapse, suggesting that factors in addition to parity play a role in the development of rectal prolapse. However, parous women with rectal prolapse had delivered significantly more children (3.3) than parous women without prolapse (2.5) (P = 0.03). The exact cause of rectal prolapse remains unclear. Childbearing appears to play a limited role in its pathogenesis since nulliparous women are also at risk of developing rectal prolapse.

Defecography↗
PubMed1997

Results of perineal procedures for the treatment of rectal prolapse.

The optimal surgical procedure for the management of rectal prolapse is still under debate. Therefore, the aim of this study was to evaluate the short-term outcome of perineal procedures in patients with rectal prolapse. Between April 1989 and April 1995, all consecutive patients at the Cleveland Clinic Florida who underwent Delorme's procedure or perineal rectosigmoidectomy with or without levatoroplasty for full-thickness rectal prolapse were evaluated. Clinical and physiological assessments were performed before and after surgery. A standard continence scoring system, based on the frequency and type of incontinence (0 = full continence, 20 = complete incontinence) was used to assess the results of each procedure. Additionally, morbidity and mortality, and clinical and functional outcomes were evaluated. Sixty-one patients underwent perineal procedures for rectal prolapse; 16 patients died from comorbid conditions after undergoing postoperative physiologic assessment. These 55 females and 6 males, with a mean age of 75 (range, 48-101) years were studied. Patients were followed up for 27.2 (6-72) months, and mean prolapse duration was 4.2 (0.2-30) years. Although mean preoperative incontinence score was 15.9 (8-20), it was 6.3 (range, 0-12) in postoperative course. Mean resection length of rectosigmoid was 23.3 (3-71) cm, and in these patients, two (3.3%) coloanal anastomotic leaks and four (6.5%) anastomotic strictures were observed. There was one postoperative death. There were statistically significant differences among the groups relative to short-term recurrence rates, postoperative incontinence scores, mean resection length, coloanal anastomotic stricture, and leak (P< 0.001). However, pre- and postoperative anal manometry did not reveal statistically significant changes (P > 0.05) in each group or among the groups. Perineal procedures were found to be safe and effective in eradicating rectal prolapse and improving fecal incontinence in the elderly.

Aged↗
PubMed1989

Perineal approaches for the treatment of complete rectal prolapse.

Perineal approaches for rectal prolapse are particularly useful in high-risk patients or in patients presenting with strangulation. Each technique is useful in certain clinical situations. Altemeier's procedure, with the addition of rectopexy and levatorplasty (Dis Colon Rectum 29: 547-552, 1986) may be the best available perineal operation for long-term correction of prolapse and treatment of associated incontinence.

Colectomy↗
PubMed1995

Physiological changes after Delorme's procedure for full-thickness rectal prolapse.

Anal sphincter pressures, rectal compliance and sensation in 19 women of mean age 77 (range 57-94) years were studied before and after Delorme's procedure for full-thickness rectal prolapse. No patient had significant problems with defaecation after operation. There were no significant changes in anal sphincter pressures but the volume of first rectal sensation decreased from a median of 140 ml before surgery to 65 ml after the procedure (P = 0.01) and the maximum tolerated rectal volume declined from a median of 249 ml to 120 ml (P = 0.001). Rectal compliance was reduced from a median of 142.9 ml/kPa to 12.2 ml/kPa (P = 0.002). Improved rectal sensation and lowered compliance are associated with a reduced incidence of defaecatory problems after Delorme's procedure.

Aged↗
PubMed1989

[Benignancy of the Delorme operation in the treatment of rectal prolapse. Indications and results].

In five patients, three male and two female (average age 74 years), with complete rectal prolapse, Delorme's operation was performed, realizing resection of the entire prolapsed rectal mucosa and the suturing the plicature of the rectal muscular layer, which permits its invagination into the muscular funnel formed by the outer sphincter. This technique, which also tenses the longitudinal muscle of the rectum that is lax in every total prolapse, partially remedies the dislocation of the hiatal ligament and improves the function of the elevator muscle, which is disordered in these patients. The five patients were followed-up for 3 to 36 months. There was no postoperative morbi-mortality in patients of advanced age or high risk had to be operated for rectal prolapse.

Aged↗
PubMed2005

Rectal prolapse following posterior sagittal anorectoplasty for anorectal malformations.

PURPOSE: Rectal prolapse is a known postoperative problem in children with anorectal malformations. The aims of this study were to determine the incidence of significant rectal prolapse (>5 mm), to objectively quantify its predisposing factors, and to offer recommendations as to its prevention and surgical treatment. METHODS: The authors reviewed their series of 1619 patients with anorectal malformations; 1169 underwent primary posterior sagittal anorectoplasty (PSARP) at their institution between 1980 and 2002, and complete records were available for 833. The series was analyzed for incidence of prolapse, type of anorectal malformation, status of the sacrum, muscle quality, associated vertebral and spinal anomalies, and postoperative constipation. A specific technique for prolapse repair was used. RESULTS: Of 833 patients, 45 developed significant rectal prolapse (3.8%). The mean age at the time of PSARP was 0.73 years (range, 0.19-5 years). The average time to recognition of prolapse following PSARP was 13.1 months. Of these 45 patients, 32 required surgical repair and of those, 3 required a second surgical repair. The incidence of prolapse varied by complexity of anorectal defect: cloaca (6.2%), rectobladder neck fistula (6.8%), rectourethral fistula (5.4%), rectovestibular fistula (1.2%), rectal atresia (0%), and rectoperineal fistula (0%). There was a significantly increased incidence of prolapse in patients with a low muscle quality score and in patients with vertebral anomalies (20% vs 3.2%). The presence of a tethered cord and an abnormal sacral ratio did not correlate with an increased incidence of prolapse. Twenty-two patients developed prolapse following colostomy closure, and of these, 12 (55%) suffered from constipation. CONCLUSIONS: The overall incidence of significant rectal prolapse following PSARP is low. Prevention of prolapse with the PSARP technique may be because of key technical steps. Patients with higher anorectal malformations, poorer muscle quality, and vertebral anomalies had a greater risk of developing postoperative rectal prolapse. The presence of tethered cord and quality of the sacrum were not predictive of postoperative prolapse. Constipation seems to be a factor in the development of prolapse.

Anal Canal↗
PubMed1990

[Status of the Delorme operation in surgery of rectal prolapse].

The surgical treatment of complete rectal prolapse has been the object of great controversy. Currently, it is believed that best results are obtained by transabdominal rectopexy. Even though these operations have low morbidity and mortality, a laparotomy may not be advisable for certain elderly or poor-risk patients. An alternative would then be the Delorme operation. The principle consists of an extensive perineal excision of the mucosa covering the prolapse, and a longitudinal plication of the rectal wall. From January 1988 to March 1989, 12 patients underwent the Delorme repair of rectal prolapse in our service with good results.

Aged↗
PubMed1991

Management of rectal prolapse in Ile-Ife, Nigeria.

Complete rectal prolapse is uncommon in adults. Out of 129,525 patients treated at our teaching hospital over a five-year period, only 29 patients were managed with complete rectal prolapse. The total mean-age was 52 years with an approximate 1:2 male-female ratio. Two of the patients had their prolapse for 16 years before presentation. Major clinical features included constipation, diarrhoea, soiling and rectal bleeding. 51.72% of the cases had partial to complete incontinence of faeces. 22 patients were treated with the simple technique posterior fixation of both rectum and sigmoid colon. Follow-up was from 6 months to 4 years, mortality was 3.44%. There had been no recurrences of the complete rectal prolapse to date.

Adult↗
PubMed2003

A novel method of demonstrating rectal prolapse.

BACKGROUND: Full thickness rectal prolapse may be difficult to view in the outpatient setting. We present a novel method to demonstrate it using equipment commonly found in the Urology clinic.

Equipment Design↗
PubMed1975

Rectal Prolapse in Nigerian Children.

Rectal prolapse is common in Nigerian children between 4 and 6 years old. Intractable cases respond favorably to the Lockhart-Mummery procedure, a simple operation which guarantees good results.

Child↗
PubMed1999

Rectal prolapse and fecal incontinence.

Rectal prolapse and fecal incontinence are problems with enormous social, functional, and economic significance to hundreds of thousands of people every year. Through a knowledgeable approach and careful diagnostic studies, many people can be cured or helped.

Fecal Incontinence↗
PubMed1997

Management of recurrent rectal prolapse.

PURPOSE: Many operations have been described for the management of rectal prolapse. Despite an overall recurrence rate of greater than 15 percent, few reviews address how to deal with this problem. This report summarizes our experience with recurrent rectal prolapse and includes suggestions for reoperative management of failed repairs from both abdominal and perineal approaches. PATIENTS AND METHODS: Fourteen patients (3 male) ranging in age from 22 to 92 (mean, 68) years underwent operative correction of recurrent rectal prolapse. Average time from initial operation to recurrence was 14 (range, 6-60) months. Initial operations (before recurrence) were as follows: perineal proctectomy and levatorplasty (10), anal encirclement (2), Delorme's procedure (1), and anterior resection (1). Operative procedures performed for recurrence were as follows: perineal proctectomy and levatorplasty (7), sacral rectopexy (abdominal approach; 3), anterior resection with rectopexy (2), Delorme's procedure (1), and anal encirclement (1). Average length of follow-up was 50 (range, 9-115) months. RESULTS: No further episodes of complete rectal prolapse were observed during this period. Preoperatively, three patients were noted to be incontinent to the extent that necessitated the use of perineal pads. The reoperative procedures failed to restore fecal continence in any of these three individuals. One patient died in the postoperative period after anal encirclement from an unrelated cause. CONCLUSION: Surgical management of recurrent rectal prolapse can be expected to alleviate the prolapse, but not necessarily fecal incontinence. Perineal proctectomies can be safely repeated. Resectional procedures may result in an ischemic segment between two anastomoses, unless the surgeon can resect a previous anastomosis in the repeat procedure. Nonresectional procedures such as the Delorme's procedure should be strongly considered in the management of recurrent rectal prolapse if a resectional procedure was performed initially and failed.

Abdomen↗
PubMedDate not supplied

[Laparoscopic rectopexy: our experience in the treatment of complete rectal prolapse].

Surgical treatments of rectal prolapse still await a final arrangement. The aim of this work is to present Authors' experience with 12 female patients who underwent laparoscopic rectopexy. The patients, aged between 67 and 84 years, were suffering of a different degree of incontinence classified according to the Browing and Parks scale. Pneumoperitoneum was induced through the Veres needle end 5 trocars were placed. The technique used was the modified Orr-Loygue. One no death was observed and only two not serious intraoperative complications were registered, in both conversion to laparotomy was not necessary. Functional result as for incontinence has been really good (disappeared in 11 cases and improved in one). Whereas regarding the constipation, no improvement was observed in those in who in it was preexisting the operation, not appearing nevertheless, as on the contrary reported by other Authors, in those in whom it wasn't present before surgical treatment. The patients, all in follow-up (range between 10 and 36 months, average 25.08), still now experienced no relapse. In conclusion, on the base of Authors' experience, laparoscopic rectopexy is considered free of particular risks and excellent in the results even if, due to the slight number of series, any definitive judgement can be expressed.

Aged↗
PubMed1997

Comparison of three perineal procedures for the treatment of rectal prolapse.

BACKGROUND: The optimal surgical procedure for the management of rectal prolapse is still under debate. Therefore, the aim of this study was to compare the short-term outcome of three perineal procedures in patients with rectal prolapse. METHODS: Between April 1989 and April 1995, all consecutive patients who had Delorme's procedure, perineal rectosigmoidectomy, or perineal rectosigmoidectomy with levatoroplasty for full-thickness rectal prolapse were clinically and physiologically assessed before and after surgery. A standard incontinence scoring system, based on the frequency and type of incontinence (0 = full continence, 20 = complete incontinence), was used to compare the results of each procedure. Additionally, morbidity and mortality and clinical and functional outcome were evaluated and compared. RESULTS: The study group of 61 patients who had perineal procedures for rectal prolapse included 55 women and 6 men, with a mean age of 75 years (range, 48 years to 101 years); 16 patients died of comorbid conditions between 3 months and 42 months after surgery. There were statistically significant differences among the groups relative to short-term recurrence rates, postoperative incontinence scores, mean resection length, coloanal anastomotic stricture, and leak. However, preoperative and postoperative anal manometry did not reveal statistically significant changes within or between the groups. CONCLUSIONS: Perineal rectosigmodectomy with levatoroplasty has the best short-term outcome for the treatment of rectal prolapse.

Aged↗