THE DELORME PROCEDURE - A USEFUL OPERATION FOR COMPLICATED RECTAL PROLAPSE IN THE ELDERLY

Full thickness rectal prolapse is a distressing and debilitating condi tion that often affects elderly patients. Fecal incontinence is usuall y present. Frequently, comorbid conditions or previous pelvic procedur es complicate surgical care. A perineal approach may be used in these patients to avoid the complications of pelvic surgery and general anes thesia. The Delorme operation involves mucosal stripping and muscle pl ication of the rectal prolapse and is performed externally under regio nal or general anesthesia. We report our experience with this procedur e in six elderly candidates who have undergone the Delorme procedure a t the UCLA Center for Health Sciences in the past year. Two men and fo ur women with a mean age of 78 +/- 12 years were followed over a mean of 11 +/- 4 months. Complicating factors included a mean of 1.7 failed prolapse operations per patient (0-6), pelvic radiation in two patien ts, and severe cardiac and pulmonary disease in two patients. Outpatie nt bowel preparations and same day admissions were used. Operative tim e averaged 80 minutes. No blood transfusions were required and postope rative stay averaged 2.7 days. A total of 67 per cent report improveme nt in continence. There was no major morbidity or mortality and only o ne recurrence, We conclude that the Delorme procedure is a safe and us eful procedure for the treatment of complete rectal prolapse. Elderly patients, patients with failed prolapse operations, and those with pri or pelvic surgery or radiation should be considered for this procedure .