Selection criteria for internal rectal prolapse repair by Delorme's transrectal excision

PURPOSE: The aim of this study was to review our results of Delorme's trans rectal excision for internal rectal prolapse, with a view to determining pr eoperative selection criteria associated with a satisfactory outcome. METHO DS: Between 1992 and 1998, 20 patients with internal rectal prolapse underw ent Delorme's transrectal excision. The last patient was excluded from the study because of a follow-up period shorter than six months. The remaining 19 patients were prospectively followed up and classified into two groups a ccording to their preoperative selection criteria. Group I consisted of eig ht patients operated on between January 1992 and October 1993 who were sele cted for surgery after medical treatment during a three-month period failed to improve symptoms. Initial results were reviewed, with a follow-up of at least six months, to assess predictive criteria correlating with poorer su rgical outcome. These adverse criteria were used to exclude patients from s election into Group IT, which included 11 patients operated on between June 1994 and June 1997. In each group the degree of improvement of symptoms wa s graded: Grade 1 = complete improvement with resolution of all symptoms; G rade 2 = significant improvement with resolution of dyschezia but not of ot her symptoms; Grade 3 = no improvement; and Grade 4 = worsened condition or reoperation. The two groups were compared according to ultimate outcomes. RESULTS: Of the Group I patients, three had preoperative chronic diarrhea, one had proximal internal rectal prolapse with rectosacral separation at de fecography, and the other two were incontinent to liquid stool. tin additio nal patient had incontinence to liquid stool but no diarrhea. Three other p atients had major perineal descent (>9 cm). Results were Grade 1 for one pa tient, Grade 2 for one patient, Grade 3 for five patients, and Grade 4 for one patient (subsequent abdominal rectopexy). Data review showed that proxi mal internal prolapse with rectosacral separation at defecography, preopera tive chronic diarrhea, fecal incontinence, and descending perineum (>9 cm o n straining) were associated with a poorer outcome (Grades 3 and 4). These adverse criteria were used to exclude patients from selection into Group II . In this group results were Grade I for seven patients and Grade 2 for fou r patients. During the course of follow-up (mean, 43; standard deviation, 1 9; range, 8-73 months), outcome was better in Group II (P = 0.007). CONCLUS ION. These data suggest that a favorable outcome can be achieved after Delo rme's transrectal excision for internal rectal prolapse by applying stringe nt patient-selection criteria.