What is Delorme's Procedure?
Delorme's procedure is a surgical technique used to treat rectal prolapse, a condition where the rectum, or the lower part of the bowel, protrudes through the anus. It is one of several surgical approaches available and is considered a perineal procedure, meaning it is performed through the anus rather than via an incision in the abdomen. The technique was first described by French surgeon Edmond Delorme in the late 19th century. Since gaining popularity, it has become a standard approach, especially for patients who may not tolerate more extensive abdominal surgery well.
Is Delorme's Procedure Considered Major Surgery?
This is a central question for many patients. The simple answer is that Delorme's procedure is not typically classified as major surgery, especially when compared to abdominal options like rectopexy. The primary reasons for this distinction are related to its less invasive nature and the lower systemic stress it places on the body.
Several factors contribute to its classification as a less invasive procedure:
- No abdominal incision: The surgery is performed entirely through the anus, avoiding the larger incisions, muscle disruption, and longer recovery associated with abdominal surgery.
- Lower surgical risk: For patients with significant co-morbidities (other health issues), the reduced invasiveness translates to lower overall surgical and anesthetic risks.
- Regional anesthesia option: Delorme's procedure can often be performed under spinal anesthesia, where the patient remains awake, which is a less stressful anesthetic approach than general anesthesia.
- Shorter recovery time: Patients generally have a shorter hospital stay and faster return to normal activities compared to those undergoing abdominal procedures.
For elderly or medically frail patients, this less invasive approach offers a safer pathway to correcting the symptoms of rectal prolapse.
The Surgical Technique: What Happens During the Procedure
The Delorme's procedure is typically performed under general or spinal anesthesia. The steps involve:
- Preparation: The patient is positioned, and the surgeon exposes the prolapsed rectum.
- Mucosal stripping: The surgeon makes a circular incision in the mucosa (inner lining) of the prolapsed rectum, a few centimeters above the anal verge. Using an electric scalpel, the inner lining is carefully peeled off the underlying rectal muscle.
- Muscle plication: Once the muscle layer is exposed, the surgeon bunches it up with stitches, like an accordion, to shorten and tighten the rectum. This pulls the rectum back into its proper anatomical position.
- Mucosal reapproximation: The surgeon trims any excess mucosal tissue and stitches the remaining mucosa back together to cover the muscle repair.
In some cases, a small rectal pack may be used to stem any bleeding; this is usually removed by staff or passed with the first bowel movement.
Comparison with Abdominal Rectopexy
While Delorme's is a less invasive option, it is crucial to understand its pros and cons compared to more extensive abdominal procedures, such as laparoscopic ventral mesh rectopexy (LVMR), which is often favored for younger or healthier patients due to lower recurrence rates.
| Feature | Delorme's Procedure | Abdominal Rectopexy (e.g., LVMR) |
|---|---|---|
| Invasiveness | Minimally invasive; perineal approach | Minimally invasive (laparoscopic) or open abdominal |
| Incision | No external abdominal incision; performed via the anus | Small abdominal incisions for laparoscopic, larger for open |
| Recovery Time | Shorter; typically 3-4 weeks for acute recovery | Longer; often around 4 weeks for laparoscopic |
| Recurrence Rate | Higher rate of recurrence (up to 42.8% in some studies) | Lower rate of recurrence (as low as 8.2% in some studies) |
| Patient Suitability | Preferred for elderly, frail, or high-risk patients | Better for younger, healthier patients seeking lower recurrence risk |
| Associated Risks | Bleeding, infection, recurrence | Higher risk of constipation and surgical complications |
Recovery After Delorme's Procedure
- Hospital Stay: Typically one to five days, shorter than more invasive procedures.
- Pain Management: Some pain is expected in the first 48 hours, managed with prescribed painkillers and possibly warm baths.
- Bowel Management: Avoiding constipation is key. Doctors recommend a high-fiber diet, plenty of fluids, and laxatives for several weeks to ensure soft, regular bowel movements.
- Activity: Gentle activity like walking can begin soon after surgery, but strenuous exercise and heavy lifting should be avoided for 4-6 weeks to prevent straining. Driving is often restricted for a few weeks.
- Hygiene: Keeping the area clean with gentle washing or sitz baths is important for the first few weeks. Small amounts of bleeding or discharge are normal.
It is important to follow all post-operative instructions provided by your medical team to ensure a smooth recovery and best possible outcome. More information on post-operative care can often be found on hospital websites, such as this patient information on the Wirral Surgeon site.
Conclusion: The Right Choice for the Right Patient
Delorme's procedure is definitively not major surgery in the same vein as an abdominal operation, but it is a serious surgical intervention. It offers a crucial, minimally invasive option for treating rectal prolapse, particularly for a specific subset of the patient population. Its benefits—less invasiveness, shorter recovery, and suitability for frail patients—are balanced by a higher rate of recurrence compared to abdominal alternatives. The decision of which surgical approach to use rests on a careful evaluation of the patient's age, overall health, the severity of the prolapse, and the patient's individual goals and risks. For many, Delorme's procedure represents an effective and safer path toward improving their quality of life by addressing the uncomfortable symptoms of rectal prolapse.
