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What operation for recurrent rectal prolapse after previous Delorme's procedure? A practical reality.
Javed, Muhammad A; Afridi, Faryal G; Artioukh, Dmitri Y.
Affiliation
  • Javed MA; Muhammad A Javed, Faryal G Afridi, Dmitri Y Artioukh, Southport and Ormskirk Hospital, Southport, Merseyside PR8 6PN, United Kingdom.
  • Afridi FG; Muhammad A Javed, Faryal G Afridi, Dmitri Y Artioukh, Southport and Ormskirk Hospital, Southport, Merseyside PR8 6PN, United Kingdom.
  • Artioukh DY; Muhammad A Javed, Faryal G Afridi, Dmitri Y Artioukh, Southport and Ormskirk Hospital, Southport, Merseyside PR8 6PN, United Kingdom.
World J Gastrointest Surg ; 8(7): 508-12, 2016 Jul 27.
Article in En | MEDLINE | ID: mdl-27462393
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.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: World J Gastrointest Surg Year: 2016 Document type: Article Affiliation country: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: World J Gastrointest Surg Year: 2016 Document type: Article Affiliation country: United kingdom