Delorme's procedure is used for
|B||Solitary rectal ulcer|
a. Two general approaches are used to achieve surgical correction of rectal prolapse: the perineal approach, which includes the Delorme and the Altemeier procedures, and the abdominal approach, which includes but is not limited to anterior resection with or without rectopexy and mesh fixation.
b. The perineal approach is less taxing on the patient and yet has a higher recurrence rate; thus, it is ideally suited for patients with high operative risk and a limited life expectancy.
c. An abdominal approach is preferred for young healthy patients because they can tolerate the procedure with low risk and are less likely to suffer a recurrence requiring reoperation.
d. The Delorme procedure is essentially a mucosal proctectomy and muscularis plicating procedure. It is ideally applied to patients with up to 3 to 4 cm of prolapse, even though the mucosal tube resected can extend up to 15 cm.
e. Even in frail, elderly patients, the Delorme procedure is associated with low rates of mortality and major morbidity, about 1% and 14%, respectively.
f. Prolapse recurrence is not uncommon and is likely underestimated because this procedure is performed in patients with limited life expectancies and therefore short follow-up.
g. The Altemeier procedure is similar to the Delorme, but rather than a mucosal resection, a full-thickness rectal resection is performed starting 1 or 2 cm above the dentate.
h. The bowel and attendant mesentery are resected. Because the pelvic cavity is entered, injury to small bowel must be avoided.
i. A full-thickness anastomosis is accomplished after the full extent of resection is completed.