The modified delorme operation

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, most poor-risk patients and for the surgeon accustomed to an anorectal approach. Modifications of the procedure include 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. Forty-four patients (with a ratio of women to men nearly 10:1) were operated on in a recent 10-yr period. Ages ranged from 26-94 with an average age of 62, predominance being in the 8th decade. There were no mortalities. Follow-up was from 2-10 yr. Failure of surgery with recurrence of prolapse was found in 3 patients (7%) and functional failure in 1 (2%). Functional results were studied in 36 patients with satisfactory results in 35. Improved technique and criteria of patient selection lowered the incidence of failure in the later years of study.