ABSTRACT
Full-thickness rectal prolapse is a life-altering disability that commonly affects older people, while it is rare in childhood and younger adults. This condition is associated with a deep rectovaginal or rectovesical peritoneal pouch, laxity of the lateral ligaments, and loss of attachment of the rectum to the sacrum. Other associated conditions are perineal descent and a patulous anus. Fecal incontinence is present in 50–70 percent of patients, particularly the elderly. Surgical procedures for the treatment of rectal prolapse can be classified as plication, excision, rectopexy, and resection. All these operations may be performed via either an abdominal or a perineal approach, the latter being more suited to high-risk patients. Among perineal operations, encircling procedures (Thiersch ring and others) are not often performed in the modern era because they only offer a mechanical barrier to the prolapse and have high rates of infection and recurrence. On the other hand, perineal rectosigmoidectomy (Altemeier procedure) is a more major procedure with the potential risks of a pelvic anastomosis. The Delorme procedure was first described in 1900 by Edmond Delorme, 1 a French military surgeon. It is a relatively safe and simple perineal technique, that involves stripping the mucosa off the prolapsing segment and suture plication of the rectal muscular wall. The operation may be performed under spinal anesthesia, so it is particularly indicated in elderly or frail patients with coexisting morbidities or in patients otherwise deemed unfit for major surgery. Having initially fallen out of favor due to anecdotal reports of high recurrence and complication rates, the procedure has gained in popularity since the report by Uhlig and Sullivan.2 the technique originally described has been modified by a number of authors to include anal sphincter repair or levatorplasty as treatment for associated fecal incontinence.
