EP149 - Is Delorme Still an Option? Analysis of 10 years of Rectal Prolapse Repair

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Purpose/Background: Full-thickness rectal prolapse (RP) remains a life-changing diagnosis for which multiple surgical approaches have been described. Rectal prolapse is surgically addressed via abdominal and perineal approaches. The abdominal approach, which involves rectopexy and/or resection, is often offered for patients who are not of advanced age, and those with fewer comorbidities who tend to tolerate major abdominal procedures reliably. In patients with significant comorbidities and frailty, perineal approaches are generally preferred. Our institution has often employed the Delorme procedure (perineal mucosectomy with muscle plication) for patients for reasons including very advanced age, frailty, multiple prior abdominal surgeries, and patient preference. Anecdotal accounts of higher recurrence rates following the Delorme procedure relative to both abdominal approaches and the Altemeier procedure (perineal proctosigmoidectomy with anastomosis) have caused this approach to fall out of favor in some institutions. We studied postoperative outcomes and patient demographics over a ten-year period following Delorme (D), Altemeier (A) and abdominal (AB) operations for RP.

Methods/Interventions: A retrospective review of patients undergoing surgical repair for RP at a single, university-affiliated academic medical center was undertaken. Following IRB approval, we queried charts for diagnosis of rectal prolapse using ICD-10 code K62.3. We included adults who had surgical repair during the period 2014-24. Data was analyzed with descriptive statistics as well as Student’s T-test and Fisher’s Exact Test.

Results/Outcomes: 101 patients met criteria (D 49 [48.5%], A 21 [20.8%], and AB 31 [30.7%]). Mean age at initial evaluation by a surgeon was significantly different between the three cohorts: 73.47 (13.66), 75.57 (12.89), and 55.94 (14.33) respectively for D, A and AB (p < 0.001). The remaining demographic data were not significantly different between the cohorts.
The mean (SD) length of stay following surgery was shorter following perianal surgery: 2.34(1.40), 3.58(4.62), and 5.67(527) respectively for D, A, and AB (p < 0.001). Recurrence rates, however, did not show a significant difference between the three cohorts: 38.8%, 52.3%, and 32.3% respectively (p=0.46). Similarly, there was no difference in the time to recurrence in months with a mean (SD) of 12.89 (18.59), 17.64 (22.63), and 30.18 (30.51) respectively for D, A, and AB (p=0.16). 17 patients required reoperation (n=21) following recurrence. Most of the patients who had subsequent surgeries had an Altemeier repair as their index case: 5 (10.2%), 9 (9.7%), and 3 (9.7%) for D, A, and AB respectively (p < 0.001).

Conclusion/Discussion: There is currently no consensus regarding the best surgical approach for RP. Our data showed no difference in rates of postoperative fecal incontinence, recurrence, or time to recurrence between D, A, and AB. There is, however, shorter postoperative length of stay following D. These data show that the Delorme procedure remains a viable option for the repair of RP despite anecdotal reports of higher recurrence rates.