Delorme's operation and sphincteroplasty for rectal prolapse and fecal incontinence

Clinical and manometric results of Delorme's operation and sphincteroplasty were assessed retrospectively in patients undergoing this procedure for fe cal incontinence and rectal prolapse. A series of 33 patients (11 males, 22 females; aged 18-83 years, mean 59) with external rectal prolapse were tre ated by Delorme's operation between 1989 and 1996. Mean follow-up was 39 mo nths (range 7-84). Sphincteroplasty was associated in 12 cases with severe fecal incontinence due to striated muscle defects. Good results were achiev ed in 27 patients (79%); prolapse recurrence was observed in 6 (21%), the m ean recurrence time being 9 months (range 1-24 months). There were no posto perative deaths. Minor complications occurred in 15 patients. Changes in pr eoperative and postoperative manometric patterns were as follows (mean+/-SE M): voluntary contraction from 59+/-6.9 to 66+/-7.1 mmHg (P=0.05), resting tone from 33+/-5 to 32+/-4.3 mmHg, rectal sensation from 59+/-5 to 61+/-5.2 mi of air (n.s.). A solitary rectal ulcer syndrome was detected in five pa tients. The histological pattern demonstrated pathological changes in 40% o f cases. Fecal incontinence was resolved in 6 of 20 cases (30%) and chronic constipation in 4 of 9 (44%). Failure (n=3) was related primarily to posto perative sepsis. The incontinence score showed a mean improvement of 35% de creasing, from 4.5+/-0.39 to 2.9+/-0.44 after surgery (P<0.01). In conclusi on, Delorme's procedure did not lead to constipation and improved anal cont inence when associated with sphincteroplasty.