General Surgery

Delorme's Procedure

OPERATION: Delorme's Procedure
ANAESTHETIC: General / spinal anaesthesia
POSITION: Lithotomy / left lateral

INDICATION:
Full-thickness rectal prolapse. [Patient details — frailty / comorbidity favouring perineal approach].

PROCEDURE:
WHO Checklist performed. Prolapse delivered and its full extent assessed.

Circumferential mucosal incision made 1–2 cm above the dentate line, through the mucosa down to the submucosal plane. Adrenaline-containing solution infiltrated into the submucosal plane to facilitate dissection and aid haemostasis.

Mucosal sleeve dissected off the underlying bowel wall musculature in the submucosal plane using diathermy, commencing anteriorly and following circumferentially. Traction on the detached mucosa and rolling it over a finger aids display of the plane. Dissection continued to the apex of the prolapse, forming a mucosal tube.

Plication sutures placed in the muscularis of the denuded bowel wall, circumferentially, reducing the redundant bowel wall — [number] × 2/0 absorbable plication sutures placed and tied sequentially. Mucosal tube excised.

Anastomosis of mucosal edges performed with interrupted absorbable sutures incorporating the underlying musculature. All sutures placed before initial sutures are tied. Completed anastomosis confirmed haemostatic and without tension. Anastomosis returned within the anus.

FINDINGS:
Full-thickness rectal prolapse [length]. Adequate mucosal sleeve excised. Muscle plication achieved.

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Regular analgesia. High fibre diet. Stool softener. Outpatient review at 6 weeks.