Rectal prolapse can be embarrassing, uncomfortable and difficult to ignore. A bulge of rectal tissue may appear through the anus during bowel movements, and some people also experience mucus, bleeding, constipation or difficulty controlling bowel movements. Understanding the surgical options is important when symptoms persist.
The Delorme procedure for rectal prolapse is a perineal operation that removes excess inner rectal lining and strengthens the rectal wall by folding and suturing its muscle layer. It suits selected patients, not everyone.
At Chirag Global Hospitals, Bangalore, a colorectal assessment can determine whether Delorme surgery or another approach is suitable.
If you have symptoms of rectal prolapse, schedule a colorectal consultation to discuss your diagnosis and treatment options.
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What is the Delorme procedure for rectal prolapse?
Delorme’s procedure is a transanal, or perineal, surgical technique used mainly for full-thickness rectal prolapse. Unlike abdominal rectopexy, it does not require an abdominal incision.
The surgeon generally performs two steps:
- A circular incision is made around the prolapsed rectal segment, and excess mucosal lining is removed.
- The exposed muscle layer is folded or plicated with sutures to shorten and reinforce the rectal wall. The remaining mucosal edges are then joined.
The aim is to reduce prolapse and strengthen the rectal wall while preserving normal bowel passage.
Who may be suitable for a Delorme procedure?
There is no single patient profile that guarantees suitability. A colorectal surgeon considers the prolapse, bowel symptoms and general health.
Delorme surgery may be considered when:
- The patient has a full-thickness rectal prolapse suitable for a perineal approach.
- The prolapse is relatively short, although selected patients with other patterns may also be considered.
- Avoiding an abdominal operation is desirable because of the patient’s health or other factors.
Perineal procedures are often considered for older or medically vulnerable patients, but age alone should not determine the choice. Medically fit patients may also be offered an abdominal approach.
When might Delorme surgery not be the best option?
Delorme is not a universal solution. Another operation may be considered when the prolapse is long, recurrent, or associated with significant bowel dysfunction.
For example, an abdominal rectopexy may be considered in a medically fit patient, while a perineal rectosigmoidectomy, commonly called the Altemeier procedure, may suit certain prolapses. The decision also depends on constipation, faecal incontinence and other bowel symptoms.
How is rectal prolapse diagnosed before surgery?
A careful examination is essential before choosing a rectal prolapse operation.
Symptom history
The doctor may ask when the tissue comes out, whether it returns by itself or needs to be pushed back, and whether you have constipation, straining, mucus, bleeding, urgency or leakage.
Physical and rectal examination
The examination helps distinguish full-thickness prolapse from haemorrhoids or mucosal prolapse. You may be asked to strain so the prolapse can be assessed.
Additional tests when needed
Depending on symptoms and medical history, tests may include colonoscopy, defecography or anorectal manometry. Not every patient needs all of these.
How does Delorme surgery work step by step?
The procedure is performed under anaesthesia. The prolapsed rectum is brought out through the anus so the surgeon can access the affected segment.
The surgeon then:
- Opens the mucosal layer around the prolapse.
- Removes redundant mucosa while preserving the underlying muscle.
- Plicates the muscle layer with sutures.
- Repositions the remaining mucosa and completes the repair.
The procedure uses the perineal route rather than an abdominal incision.
What are the benefits of the Delorme procedure?
Potential advantages may include:
- A perineal approach without an abdominal incision.
- Less extensive abdominal dissection than abdominal rectopexy.
- An option when an abdominal operation may carry greater physiological burden.
- Direct treatment of the prolapsed rectal segment.
Have questions about Delorme surgery? Contact Chirag Global Hospitals to discuss whether a perineal approach may be appropriate for you.
What are the risks and possible complications?
As with any operation, Delorme surgery has potential risks. These can include:
- Bleeding or infection
- Temporary difficulty passing urine
- Constipation, urgency or changes in bowel habits
- Pain or discomfort during recovery
- Narrowing of the anal or rectal passage in uncommon cases
- Persistent faecal incontinence when underlying muscle or nerve dysfunction remains
- Recurrence of rectal prolapse
Recurrence is an important point to discuss before surgery. Risk varies between patients and studies and can be influenced by the type and extent of prolapse, previous surgery, bowel function and surgical technique. No prolapse operation can promise that recurrence will never occur.
Delorme vs Altemeier vs abdominal rectopexy
There is no single “best” rectal prolapse operation for everyone.
Delorme procedure
A perineal procedure involving mucosal sleeve removal and plication of the rectal muscle. It may be considered for selected full-thickness prolapse when a perineal approach is appropriate.
Altemeier procedure
A perineal rectosigmoidectomy in which the prolapsed rectum and a portion of sigmoid colon are removed through the anus. It may be considered for longer prolapse or selected patients where this approach is appropriate.
Abdominal rectopexy
An abdominal operation that mobilises and fixes the rectum to improve support. Different techniques can be used, sometimes with minimally invasive surgery. It may be considered for medically fit patients based on prolapse characteristics and bowel-function needs.
The choice depends on the individual.
What is recovery like after a Delorme procedure?
Recovery varies. Your surgeon will provide instructions about diet, bowel movements, wound care, medicines and activity.
Avoid excessive straining and follow advice designed to keep bowel movements comfortable. Fluids, appropriate fibre and prescribed stool-softening measures may be recommended.
Follow-up remains important even when symptoms improve. Your surgeon can assess healing and address constipation, incontinence or other bowel-function concerns.
Can Delorme surgery improve constipation or incontinence?
It can, but improvement is not guaranteed.
Rectal prolapse may contribute to incomplete evacuation and faecal incontinence, and correcting it may improve these symptoms in some patients. However, constipation or incontinence can also have separate causes, so treatment should consider the whole bowel-function picture.
When should you see a colorectal surgeon?
If tissue repeatedly comes out through the anus, especially during bowel movements, do not assume it is simply piles.
Seek specialist assessment for:
- A visible bulge during straining
- Tissue that needs to be pushed back
- Mucus or bleeding
- Constipation or difficulty emptying the bowel
- Faecal leakage or reduced bowel control
Early assessment allows the cause to be confirmed and treatment options to be discussed.
Final thoughts
The Delorme procedure is an established perineal operation for selected patients with rectal prolapse. It works by removing the redundant mucosal lining and reinforcing the rectal muscle layer, without an abdominal incision.
The key question is whether Delorme is appropriate for your prolapse, bowel symptoms and overall health. A colorectal surgeon can compare the available approaches and explain their benefits and risks.
Looking for rectal prolapse evaluation in Bangalore? Contact Chirag Global Hospitals for a consultation with a colorectal specialist and discuss a treatment plan based on your diagnosis.
Frequently Asked Questions About the Delorme Procedure
What is the Delorme procedure for rectal prolapse?
It is a perineal operation that removes excess rectal mucosa and plicates the muscle layer to treat selected cases of full-thickness rectal prolapse.
Who is a candidate for Delorme surgery?
Candidates are selected after examination. The procedure may suit certain shorter prolapses and patients for whom a perineal approach is appropriate.
Is Delorme surgery painful?
Some pain or discomfort can occur after surgery. Your surgical team can prescribe pain relief and provide instructions for bowel care during recovery.
How long does recovery after Delorme surgery take?
Recovery varies by patient and procedure. Your surgeon will advise when to resume normal activities based on healing and bowel function.
Can rectal prolapse come back after Delorme surgery?
Yes. Recurrence is possible after any rectal prolapse operation. Individual risk depends on factors such as prolapse characteristics, previous surgery and technique.
Is Delorme better than Altemeier surgery?
Neither is universally better. The choice depends on prolapse length, health, bowel symptoms, previous surgery and the surgeon’s assessment.
