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01.09.2015 | Original Article | Ausgabe 9/2015

Techniques in Coloproctology 9/2015

Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier

Zeitschrift:
Techniques in Coloproctology > Ausgabe 9/2015
Autoren:
F. Elagili, B. Gurland, X. Liu, J. Church, G. Ozuner

Abstract

Purpose

Data comparing surgical outcomes and quality of life (QOL) following perineal repair of rectal prolapse are limited. The aim of our study was to compare the short-term outcome and QOL of two perineal procedures in patients with rectal prolapse.

Methods

All patients with full-thickness rectal prolapse admitted to our institution and undergoing Delorme and Altemeier procedures from 2005 to 2013 were identified using an institutional, IRB-approved rectal prolapse database. Short-term outcomes and QOL were compared.

Results

Seventy-five patients (93 % female) underwent rectal prolapse surgery: 22 Altemeier and 53 Delorme, mean age 72 ± 15 years. Sixty-six percentage of patients were ASA grade III or IV (Table 1). The median hospital stay was longer in Altemeier’s group [4 (1–44) days vs. 3 (0–14) days; p = 0.01]. After a median follow-up of 13 (1–88) months, the rate of recurrent prolapse was 14 % (n = 11) [Altemeier 2 (9 %) vs. Delorme 9 (16 %) p = 0.071]. Postoperative complication rate was 12 % (n = 9) [Altemeier 5 (22 %) vs. Delorme 4 (7 %), p = 0.04]. There was no mortality. The Cleveland Global Quality of Life scores in each group were 0.6 ± 0.2 and 0.5 ± 0.3, respectively (p = 0.59), and were not changed by the surgery.
Table 1
Patient’s characteristics and procedures outcomes
 
Total (N = 75)
Altemeier’s (N = 22)
Delorme’s (N = 53)
p value
Age
 Mean (SD)
72 ± 15
75.3 ± 14.1
69.4 ± 15.4
0.14
Sex
 Female
70 (93 %)
21 (95 %)
49 (92 %)
0.99
ASA score
 1
1 (14 %)
0
1 (2 %)
0.54
 2
23 (33 %)
7 (33 %)
16 (33 %)
 3
42 (56 %)
11 (52 %)
31 (58 %)
 4
8 (11 %)
3 (14 %)
5 (9 %)
BMI
 Mean (SD)
24.3 ± 7.3
22.4 ± 10.8
25 ± 4.9
0.20
Intraoperative blood loss/ml, median
30 (10–300)
50 (10–200)
25 (10–300)
0.95
Postoperative stool frequency/per day, median
6 (1–40)
4 (1–40)
6 (3–10)
0.78
Pre-op FIQL
 Mean (SD)
7.5 ± 4.7
5.3 ± 4.1
7.9 ± 4.8
0.32
Post-op FIQL
 Mean (SD)
7.2 ± 5.2
5.9 ± 0.8
7.4 ± 5.6
0.72
Pre-op CSI
 Mean (SD)
34.4 ± 14.1
33.5 ± 10.8
34.6 ± 15.1
0.89
Post-op CSI
 Mean (SD)
31.3 ± 15.8
40.0 ± 17
29.9 ± 15.9
0.42
Pre-op CGQL
  Mean (SD)
0.5 ± 0.3
0.3 ± 0.3
0.5 ± 0.3
0.08
Post-op CGQL
 Mean (SD)
0.5 ± 0.3
0.6 ± 0.2
0.5 ± 0.3
0.59
ASA American Society of Anesthesiologists, BMI body mass index, FIQL fecal incontinence QOL, CSI Constipation Severity Index, CGQL Cleveland Global Quality of Life

Conclusions

In patients where abdominal repair of rectal prolapse is judged to be unwise, a Delorme procedure offers short-term control of the prolapse with low risk of complications and with reasonable function. In addition, patients that recur after a Delorme procedure can undergo another similar transanal procedure without compromising the vascular supply of the rectum.

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