Recurrence rate after Delorme’s procedure with simultaneous placement of a Thiersch suture

Abstract

Introduction Rectal prolapse is a debilitating condition usually affecting elderly women. The management is generally surgical but the optimal operation remains unclear. The recurrence rate after Delorme's procedure has been found to be similar to that for an abdominal approach. Thiersch sutures have been associated with high rates of complications and recurrence. The aim of this study was to compare the outcomes of Delorme's procedure with those of a combined Delorme-Thiersch procedure. Methods A retrospective case note review was performed of all patients who underwent Delorme's procedure for rectal prolapse between 2008 and 2014 in a single centre. Results Sixty-seven patients (63 women) underwent Delorme's procedure during the study period. The majority (85%) of patients were over 75 years old. Twelve patients had a Thiersch suture placed at the time of the procedure. The median length of stay was 3 days (range: 0-19 days). Postoperative bleeding requiring either transfusion or readmission occurred in five patients (7.5%) and two patients (3.0%) were readmitted with pain. There was no difference in the rate of complications regardless of whether a Thiersch suture had been placed. Recurrence occurred in 8.3% of those who had a Thiersch suture compared with 21.8% of those who did not (p=0.26). There was no difference in the median time to recurrence between the groups. Conclusions There was no increase in complications after placement of a Thiersch suture with Delorme's procedure. The rate of recurrence could potentially be decreased with this combined technique. Additional studies are required to investigate this further.

Strangulated recurrent rectal prolapse after a Delorme intervention, a case report

“…It has a higher recurrence rate than does the Altemeier procedure, probably because we do not enter the peritoneal cavity. According to the literature, recurrence ranges between 7% and 27%, similar to that of the abdominal approaches …”

“…Warwick et al developed a combined Delorme‐Thiersch (anal encirclement) procedure to reduce recurrence from 21% to 8%, with no increases in the complication rate.…”

“…According to the literature, recurrence ranges between 7% and 27%, 3,5 similar to that of the abdominal approaches. 2 Warwick et al 2 developed a combined Delorme-Thiersch (anal encirclement) procedure to reduce recurrence from 21% to 8%, with no increases in the complication rate.…”

“…The perianal approaches include the Delorme and Altemeier procedures at 50%‐60% of all transperineal interventions. No formal consensus or guidelines have been described to support a single gold standard intervention …”

“…Between the abdominal and perineal approaches and with the emergence of minimally invasive surgery, various studies have shown that the perineal approach is no longer restricted, but remains preferred for surgically unfit patients. Recurrence rates and morbidities are almost equal …”