Evaluation and outcome of the Delorme procedure in the treatment of rectaloutlet obstruction

PURPOSE: This study was designed to assess the results of the Delorme proce dure in the treatment of patients with rectal outlet obstruction. METHODS: A descriptive retrospective study from October 1989 to October 1997 was und ertaken. Thirty-four patients with an abnormal defecography documenting rec tal outlet obstruction caused by internal rectal prolapse or a combination of internal rectal prolapse and rectocele were included in the study. RESUL TS: Thirty-four patients (33 females) ages 35 to 82 (mean, 61.4) years were followed up for the duration of the study (mean follow-up, 43 months). Twe nty-six patients (76.4 percent) reported a good to excellent overall result after the Delorme procedure. Eight patients (23.6 percent) reported fair t o poor results. Symptomatic improvement was observed in 89.7 percent for pa tients who had incomplete evacuation, and in 88.5 percent of patients who h ad constipation. There was improvement in 78.6 percent of patients with ble eding per rectum, in 92.9 percent of patients with straining, and in 82.4 p ercent of patients with the need to manually assist in defecation by pushin g in the perineum or vagina. Discontinuation of laxative use after the proc edure was reported by 66.7 percent of patients. Improvement in the patients with some degree of incontinence was seen in 33.3 percent. Twelve patients (35.3 percent) experienced one or more complications. The procedure was pe rformed in an outpatient setting in 71 percent of the patients. CONCLUSIONS : The Delorme procedure for the treatment of rectal outlet obstruction can be done with minimal morbidity, short hospital stay often in an outpatient setting, with good functional results, and with an overall patient satisfac tion above 75 percent.