Delorme’s procedure in rectal prolapse - general and visceral surgery

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date of publication: 05.07.2014

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  • Diagnostic assessment; dissecting an anterior mucosal flap

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    144-6

    With the patient in lithotomy position, perform a digital rectal examination followed by slow and careful dilation of the anal sphincter. Insert the Parks retractor

    Injection into the anterior rectal mucosa, horizontal mucosal incision 5-8 mm proximal to the dentate line and careful excision of a longitudinally ovoid mucosal flap of up to 10 x 8 cm in size in cranial direction with diathermy while sparing the underlying muscle coat. Carry out the dissection in semicircular fashion, from 9 o'clock to 3 o'clock horizontally and vertically along the entire length of the rectocele.

  • Plicating the muscle coat

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    Gradually plicate the anterior rectal wall in the vertical direction with several absorbable sutures (size 0). This usually requires 5 - 8 stitches. The muscularis mucosae may be concertinaed or fixed in three layers.

  • Resecting the mucosa

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    Resect the excess mucosa and then adapt the mucosal margins.

  • Suturing the mucosa

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    Adapt the mucosa with several interrupted sutures.

  • Pre- and postoperative finding

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    The preoperative rectocele has been resolved almost completely, with the anterior rectal wall clearly stabilized.