Summary
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.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Delorme R: Sur le Traitement des Prolapsus du Rectum Totaux par L' Excision de la Muquese Rectale au Rectal-Colique. Bull Mem Soc Chir Paris 26: 498, 1900
Alexander RM, McElwain J: Personal communication to the authors
David V: Prolapse of the recutm, Lewis' Practice of Surgery. Hagerstown. W F Prior, 1929, vol 7, p 69
Ejaife JA, Elias EG: Delorme's repair for rectal prolapse. Surg Gynecol Obstet 144: 757, 1977
Hayden EP: Prolapse of the rectum. Surg Clin North Am 27: 1062 (Oct) 1947.
Moskalenko VW: Modification of Delorme's resection of rectal mucosa for prolapse of the rectum. Int Surg 58: 192, 1973
Nay HR, Blair CR: Perineal surgical repair of rectal prolapse. Am J Surg 123: 577, 1972
Swinton NW, Palmer TE: The management of rectal prolapse and procidentia. Am J Surg 99: 144, 1960
Deucher F, Blessing H: Prolapsus and sphincter insufficiency. Prog Surg 13: 98, 1974
Aminev A, Malyshev I: Quoted by Boutsis C, Ellis H
Boutsis C, Ellis H: The Ivalon-sponge-wrap operation for rectal prolapse: An experience with 26 patients. Dis Colon Rectum 17: 21, 1974
Schofield TL: Polyvinyl alcohol sponge: An inert plastic for use as a prosthesis in the repair of large hernias. Br J Surg 42: 618, 1955
Küpfer CA, Goligher JC: One hundred consecutive cases of complete prolapse of the rectum treated by operation. Br J Surg 57: 481, 1970
Lockhart-Mummery HE: Procidentia: Recent experiences in the treatment of rectal prolapse (symposium). Dis Colon Rectum 15: 347, 1972
Morgan CN, Porter NH, Klugman DJ: Ivalon (polyvinyl alcohol) sponge in the repair of complete rectal prolapse. Br J Surg 59: 841, 1972
Penfold JC, Hawley PR: Experiences of Ivalon-sponge implant for complete rectal prolapse at St. Mark's Hospital, 1960–70. Br J Surg 59: 846, 1972
Beahrs OH, Theuerkauf FJ Jr, Hill JR: Procidentia: Surgical treatment (symposium). Dis Colon Rectum 15: 337, 1972
Castro AF: Procidentia of the rectum. Dis Colon Rectum 1: 97, 1958
Conyers CL, Cullen PK Jr: Correction of rectal prolapse by anterior resection. West J Med 121: 270, 1974
Theuerkauf FJ Jr, Beahrs OH, Hill JR: Rectal prolapse: Causation and surgical treatment. Ann Surg 171: 819, 1970
Bomar RL, Sawyers JL: Transabdominal proctopexy (Ripstein procedure) for massive rectal prolapse. Am Surg 43: 97, 1977
Gordon PH, Hoexter B: Complications of the Ripstein procedure. Dis Colon Rectum 21: 277, 1978
Ripstein CB: Procidentia: Definitive corrective surgery (symposium). Dis Colon Rectum 15: 334, 1972
Ripstein CB, Lanter B: Etiology and surgical therapy of massive prolapse of the rectum. Ann Surg 157: 259, 1963
Davidian VA Jr, Thomas CG Jr: Trans-sacral repair of rectal prolapse: Efficacy of treatment in thirty consecutive patients. Am J Surg 123: 231, 1972
Thomas CG Jr, Jenkins SG Jr: Results of the posterior approach in the repair of rectal prolapse. Ann Surg 161: 897, 1965
Gabriel WB: The treatment of complete prolapse of the rectum by rectosigmoidectomy (Auffret-Mikulicz-Miles procedure). Dis Colon Rectum 1: 241, 1958
Nigro ND: Procidentia of the rectum. Surg Clin North Am 58: 539 (June) 1978
Sullivan ES, Leaverton GH, Hardwick CE: Transrectal perineal repair: An adjunct to improved function after anorectal surgery. Dis Colon Rectum 11: 106, 1968
Parks AG, Swash M, Urich H: Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 18: 656, 1977
Author information
Authors and Affiliations
Additional information
Read at the meeting of the American Society of Colon and Rectal Surgeons, Atlanta, Georgia, June 10 to 14, 1979. This paper received the Piedmont Society of Colon and Rectal Surgeons Award.
About this article
Cite this article
Ehlig, B.E., Sullivan, E.S. The modified delorme operation: Its place in surgical treatment for massive rectal prolapse. Dis Colon Rectum 22, 513–521 (1979). https://doi.org/10.1007/BF02586995
Issue Date:
DOI: https://doi.org/10.1007/BF02586995