The Delorme repair for full-thickness rectal prolapse: a retrospective review

Background

The purpose of this study was to assess our colorectal surgical training program experience with the Delorme procedure for complete rectal prolapse.

Methods

Consecutive patients were identified from a surgical database and evaluated by chart review.

Results

Seventy-six patients with a mean follow-up period of 3.6 years were included. Outcomes included a recurrence rate of 14.5%, an overall complication rate of 25%, and a surgical site-specific complication rate of 8%. For patients younger than 50 years old (mean age, 36 y; range, 19-49 y), the recurrence rate was 8% with a mean follow-up period of 4.1 years. Their total complication rate was 15%, with no surgery site-specific complications.

Conclusions

Our results are consistent with previously published experiences in that most preoperative evacuatory symptoms resolve with repair of the prolapse, and serious complications are uncommon. The observation that recurrence and complication rates may be lower in younger medically fit patients suggests the Delorme repair need not be restricted specifically to older, medically unfit patients.     

Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation(Part Ⅱ:Treatment)

The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation.There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation.Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre.Osmotic laxatives may be effective in patients who do not respond to fibre supplements.Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives.Controlled trials have shown that serotoninergic enterokinetic agents,such as prucalopride,and prosecretory agents,such as lubiprostone,are effective in the treatment of patients with chronic constipation.Surgery is sometimes necessary.Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders,generalised motility disorders or psychological disorders.Randomised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation.Many surgical procedures may be used to treat obstructed defecation in patients with acquired anatomical defects,but none is considered to be the gold standard.Surgery should be reserved for selected patients with an impaired quality of life.Obstructed defecation is often associated with pelvic organ prolapse.Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse,but the efficacy and safety of such procedures have not yet been established.     

Delorme手术治疗21例完全性直肠脱垂的效果观察

目的本研究旨在观察Delorme术式对完全性直肠脱垂的治疗效果,以探讨Delorme术用于治疗完全性直肠脱垂的可行性。方法选取新疆维吾尔自治区人民医院胃肠外科2006—2010年间行Delorme手术的完全性直肠脱垂患者21例,其中女性14例,男性7例。采用Wexner排便失禁评分以及肛门压力检测法对患者术前和术后的排便情况进行比较。结果21例患者在手术前均存在对稀水便、固体便以及排气失禁的情况。术后4例患者分别于第6,8,12,18个月时出现病情复发,占总人数的19．O％。术后失访患者2例,在余下的19例患者中,15例（78．9％）排便失禁有不同程度的改善,其中8例（42．1％）明显改善,7例（36．8％）完全治愈,其余4例（21．1％）效果不明显;有1例（5．3％）术前未诉便秘,但术后却出现便秘。结论Delorme手术用于治疗完全性直肠脱垂具有疗效确切、并发症少、术后便秘发生率低等特点,其在直肠脱垂的治疗中具有重要价值。     

Anatomic specificity in the diagnosis and treatment of internal rectal prolapse

Distal bowel evacuation was studied by cinedefecography in 85 women with obstinate constipation, tenesmus, and incomplete evacuation in whom a diagnosis of internal rectal intussusception was clinically suspect. Sixty-five patients showed radiographic evidence of intussusception—mostly of the distal rectum, without rectosacral separation. Patients with distal intussusception who did not respond to nonoperative measures were treated by Delorme's transrectal excision with excellent results. Internal rectal intussusception is a real and demonstrable entity which may be symptomatically disabling and whose documentation may be integral to effective and anatomically specific treatment. The syndromes of perineal descent, solitary rectal ulcer, levator syndrome and so-called recurrent hemorrhoids may be diagnostic intermediaries in the evolution of internal rectal intussusception. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 6 to 10, 1985.     

Rectal prolapse and surgery for incontinence

Pelvic floor disorders, which include rectal prolapse (RP) and faecal incontinence (FI), are benign conditions, which are not life threatening but affect the quality of life. This is usually a disease of elderly, mostly frail patients. Management is multidisciplinary based on the symptoms, co-morbidities and patient's expectations.     

经会阴行改良Delorme术治疗完全性直肠脱垂16例

为观察改良Delorme术治疗成人完全性直肠脱垂的疗效,对16例成人完全性直肠脱垂患者行改良Delorme术治疗。结果显示,16例均顺利完成手术,无手术死亡病例。平均手术时间为75min（60∽110min）,平均住院时间为6d（5～9d）。15例一次性手术治愈,1例在随访过程中复发,再次采用PPH治愈。结果表明,改良后的Delorme术式治疗成人完全性直肠脱垂,患者痛苦小,手术操作简便,手术时间和住院时间明显缩短,住院费用低,手术安全性高,且术后控便能力明显提高,复发率低,患者满意度高。     

Delorme术式治疗完全性直肠脱垂的临床观察

目的探讨Delorme术式治疗直肠脱垂的临床效果。方法对2004年1月至2010年10月26例完全性直肠脱垂患者采用Delorme手术治疗的临床资料作回顾性分析。结果零死亡率,复发率为7.69%（2/26）。80%（16/20）肛门失禁患者肛门控便能力提升（最大肛管静息压、最大肛管自主收缩压、最大耐受容积明显增加）。平均住院时间7d（6～10d）。术后无疼痛16例（61.5%）,中度7例（26.9%）,高度3例（11.5%）。手术满意度高18例（69.2%）,中5例（19.2%）,低3例（11.5%）。结论 Delorme术式治疗完全性直肠脱垂有术后疼痛轻、复发率低、手术满意度高、肛门控便能力提升等特点。