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 ...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). Approximately16% of the patients suffered minor complications such as- urinary retention, delayed defaecation and infected haematoma. One patient died constituting postoperative 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 patientrelated 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.展开更多
Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in...Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in terms of recurrence and improvement of fecal incontinence. In this prospective study, we enrolled patients suffering from short, full-thickness rectal prolapse associated with traumatic fecal incontinence who had been admitted to Alexandria Main University Hospital during the period of May 2010-January 2013. Preoperative data including cause of trauma, duration of symptoms, results of anal manometry, and degree of fecal incontinence using Wexner score were collected from all patients. Delorme＇s procedure with overlap sphincteroplasty was done in all patients. Recurrence of prolapse and improvement of fecal incontinence were assessed after 1, 3, 6 and 12 months. The study included 13 patients aged （32±8.7） years, 9 females and 4 males. Cause of sphincteric injury included previous anal surgery in 7 patients and normal labor in 6 patients. Duration between sphinctefic injury and operation was （8.08±2.47） months. Preoperative Wexner＇s mean score was 16.07±3.4. Early postoperative complications included superficial wound infection （69.2%）, minor wound dehiscence （61.5%）, and postoperative bleeding （7.6%）. Recurrence was detected in 1 patient at 6 month follow-up. Wexner＇s score showed significant improvement for all patients after 6 months （4.00±2.04）. In conclusion, combination of Delorme＇s procedure and sphincteroplasty for treatment of patients with short complete rectal prolapse associated with traumatic fecal incontinence is a safe, effective surgical management with satisfactory results regarding anatomical and functional outcomes.展开更多
PURPOSE: The aim of this study was to assess long- term outcome of Orr- Loygue rectopexy and Delorme’ s procedures in total rectal prolapse management. METHODS: Data were collected retrospectively from 1978 to 2001. ...PURPOSE: The aim of this study was to assess long- term outcome of Orr- Loygue rectopexy and Delorme’ s procedures in total rectal prolapse management. METHODS: Data were collected retrospectively from 1978 to 2001. Statistical analysis was performed by chi- squared test and Student’ s t - test. RESULTS: 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 symtom 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. CONCLUSIONS: 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.展开更多
文摘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). Approximately16% of the patients suffered minor complications such as- urinary retention, delayed defaecation and infected haematoma. One patient died constituting postoperative 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 patientrelated 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.
文摘Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in terms of recurrence and improvement of fecal incontinence. In this prospective study, we enrolled patients suffering from short, full-thickness rectal prolapse associated with traumatic fecal incontinence who had been admitted to Alexandria Main University Hospital during the period of May 2010-January 2013. Preoperative data including cause of trauma, duration of symptoms, results of anal manometry, and degree of fecal incontinence using Wexner score were collected from all patients. Delorme＇s procedure with overlap sphincteroplasty was done in all patients. Recurrence of prolapse and improvement of fecal incontinence were assessed after 1, 3, 6 and 12 months. The study included 13 patients aged （32±8.7） years, 9 females and 4 males. Cause of sphincteric injury included previous anal surgery in 7 patients and normal labor in 6 patients. Duration between sphinctefic injury and operation was （8.08±2.47） months. Preoperative Wexner＇s mean score was 16.07±3.4. Early postoperative complications included superficial wound infection （69.2%）, minor wound dehiscence （61.5%）, and postoperative bleeding （7.6%）. Recurrence was detected in 1 patient at 6 month follow-up. Wexner＇s score showed significant improvement for all patients after 6 months （4.00±2.04）. In conclusion, combination of Delorme＇s procedure and sphincteroplasty for treatment of patients with short complete rectal prolapse associated with traumatic fecal incontinence is a safe, effective surgical management with satisfactory results regarding anatomical and functional outcomes.
文摘PURPOSE: The aim of this study was to assess long- term outcome of Orr- Loygue rectopexy and Delorme’ s procedures in total rectal prolapse management. METHODS: Data were collected retrospectively from 1978 to 2001. Statistical analysis was performed by chi- squared test and Student’ s t - test. RESULTS: 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 symtom 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. CONCLUSIONS: 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.
