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Erschienen in:
01.09.2015 | Original Article
Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier
Erschienen in: Techniques in Coloproctology | Ausgabe 9/2015
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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 |
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.