VM1 - Enhancing Surgical Outcomes: A Case Study of the Delorme Procedure for Rectal Prolapse

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Purpose/Background: In this video, we present a Delorme procedure for rectal prolapse. The patient has a history of robotic ultra-low anterior resection (LAR) with hand-sewn coloanal anastomosis and diverting loop ileostomy in May 2023 for a rectal adenocarcinoma. The postoperative course for the LAR was unremarkable, except for a short duration of ileus. We chose the Delorme procedure over other approaches due to the patient’s previous radiotherapy and the presence of a hostile deep pelvis from the prior surgery.

Methods/Interventions: We managed a 62 year old male who presents with anal pain for seven months, as well as bleeding and mucus per rectum and sensation of a rectal bulge. We performed a Delorme procedure given the patient’s characteristics. The patient was taken to the operating room and was positioned in the prone jackknife position. Local anesthesia was then injected into the prolapsed rectal mucosa. Next, the Lone Star retractor was used to provide adequate exposure. Upon examination, a 6 cm prolapse of the rectum was noted. A mucosal dissection was then performed down to the level of the muscularis propria. The incision was made through the mucosa to the muscular layer, but not full thickness through the entire rectal wall circumferentially. Next, a sleeve of the mucosal layer was dissected off the muscular layer of the rectal wall. A proper mucosa-to-mucosa approximation was then done with multiple interrupted Vicryl 3-0 sutures, placed a few millimeters apart. Finally, hemostasis was achieved, and the rectal prolapse was observed to be fully reduced.

Results/Outcomes: The patient’s postoperative course was unremarkable, and he was discharged on post-operative day one. He did not suffer any post-operative complications. After two months, he came back for closure of his ileostomy and extensive pelvic floor therapy was recommended. At six months follow up, there was no evidence of recurrence.

Conclusion/Discussion: The Delorme procedure has historically been associated with a higher risk of recurrence compared to other procedures for rectal prolapse. However, in the context of previous extensive pelvic surgery, such as ultra-low anterior resections, and prior radiation therapy, it is an acceptable alternative. In our case, this technique has been shown to be effective and safe, with a low complication rate and faster recovery, and therefore, it should not be restricted only to older, frail patients.