Journal Article

Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier

Elagili, F., Liu, X., Gurland, B., Church, J., Ozuner, G.

2015

Overview

Purpose Data comparing surgical outcomes and quality of life (QOL) following perineal repair of rectal prolapse are limited. The aim of our study was to compare the short-term outcome and QOL of two perineal procedures in patients with rectal prolapse. Methods All patients with full-thickness rectal prolapse admitted to our institution and undergoing Delorme and Altemeier procedures from 2005 to 2013 were identified using an institutional, IRB-approved rectal prolapse database. Short-term outcomes and QOL were compared. Results Seventy-five patients (93 % female) underwent rectal prolapse surgery: 22 Altemeier and 53 Delorme, mean age 72 ± 15 years. Sixty-six percentage of patients were ASA grade III or IV (Table  1 ). The median hospital stay was longer in Altemeier’s group [4 (1–44) days vs. 3 (0–14) days; p  = 0.01]. After a median follow-up of 13 (1–88) months, the rate of recurrent prolapse was 14 % ( n  = 11) [Altemeier 2 (9 %) vs. Delorme 9 (16 %) p  = 0.071]. Postoperative complication rate was 12 % ( n  = 9) [Altemeier 5 (22 %) vs. Delorme 4 (7 %), p  = 0.04]. There was no mortality. The Cleveland Global Quality of Life scores in each group were 0.6 ± 0.2 and 0.5 ± 0.3, respectively ( p  = 0.59), and were not changed by the surgery. Table 1 Patient’s characteristics and procedures outcomes Total ( N  = 75) Altemeier’s ( N  = 22) Delorme’s ( N  = 53) p value Age  Mean (SD) 72 ± 15 75.3 ± 14.1 69.4 ± 15.4 0.14 Sex  Female 70 (93 %) 21 (95 %) 49 (92 %) 0.99 ASA score  1 1 (14 %) 0 1 (2 %) 0.54  2 23 (33 %) 7 (33 %) 16 (33 %)  3 42 (56 %) 11 (52 %) 31 (58 %)  4 8 (11 %) 3 (14 %) 5 (9 %) BMI  Mean (SD) 24.3 ± 7.3 22.4 ± 10.8 25 ± 4.9 0.20 Intraoperative blood loss/ml, median 30 (10–300) 50 (10–200) 25 (10–300) 0.95 Postoperative stool frequency/per day, median 6 (1–40) 4 (1–40) 6 (3–10) 0.78 Pre-op FIQL  Mean (SD) 7.5 ± 4.7 5.3 ± 4.1 7.9 ± 4.8 0.32 Post-op FIQL  Mean (SD) 7.2 ± 5.2 5.9 ± 0.8 7.4 ± 5.6 0.72 Pre-op CSI  Mean (SD) 34.4 ± 14.1 33.5 ± 10.8 34.6 ± 15.1 0.89 Post-op CSI  Mean (SD) 31.3 ± 15.8 40.0 ± 17 29.9 ± 15.9 0.42 Pre-op CGQL   Mean (SD) 0.5 ± 0.3 0.3 ± 0.3 0.5 ± 0.3 0.08 Post-op CGQL  Mean (SD) 0.5 ± 0.3 0.6 ± 0.2 0.5 ± 0.3 0.59 ASA American Society of Anesthesiologists, BMI body mass index, FIQL fecal incontinence QOL, CSI Constipation Severity Index, CGQL Cleveland Global Quality of Life Conclusions In patients where abdominal repair of rectal prolapse is judged to be unwise, a Delorme procedure offers short-term control of the prolapse with low risk of complications and with reasonable function. In addition, patients that recur after a Delorme procedure can undergo another similar transanal procedure without compromising the vascular supply of the rectum.

• Publisher: Springer Milan,Springer Nature B.V
• Subject: Abdominal Surgery / Aged / Aged, 80 and over / Colorectal Surgery / Digestive System Surgical Procedures - methods / Digestive System Surgical Procedures - statistics & numerical data / Female / Gastroenterology / Humans / Length of Stay / Male / Medicine / Medicine & Public Health / Middle Aged / Original Article / Perineum - surgery / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Proctology / Quality of Life / Rectal Prolapse - surgery / Rectum - surgery / Recurrence / Retrospective Studies / Surgery / Transanal Endoscopic Surgery - methods / Transanal Endoscopic Surgery - statistics & numerical data / Treatment Outcome