Comparative Study Between Delorme Operation With or Without Postanal Repair in Treatment of Complete Rectal Prolapse
Condition: Rectal Prolapse
MeSH terms: Rectal Prolapse; Prolapse
Study type: Interventional

Summary: 
      The aim of the study is to compare Delorme operation alone or with post anal repair and
      levatorplasty for treating complete rectal prolapse.consecutive patients who were treated for
      complete rectal prolapse at the Colorectal Surgery Unit were eligible for the study.The
      patients were randomized into two groups: Group I: consisted of patients were subjected to
      delorme operation only. Group II: consisted of patients were subjected to delorme operation
      with post anal repair and levatorplasty.
    

Detailed description: 
      Rectal procidentia frequently occurs in older women. Patients usually present with obstructed
      defecation or fecal incontinence. This study is to compare Delorme operation alone or with
      post anal repair and levatorplasty for treating complete rectal prolapse. Consecutive
      patients who were treated for complete rectal prolapse at our Colorectal Surgery Unit were
      eligible for the study. Exclusion criteria include pregnant female, any patients with
      previous anal surgery, pudendal nerve neuropathy, anal fistula and sepsis or coagulopathy.
      All patients underwent clinical evaluation, proctoscopic examination, and sigmoidoscopy.
      Anorectal physiology studies consisted of anal manometry and measurement of pudendal nerve
      terminal motor latency (PNTML) to exclude pudendal nerve entrapment syndrome. Patients
      enrolled in the study were randomized into three groups using the closed envelope method. The
      envelopes were drawn and opened by a nurse not otherwise engaged in the study in the
      operating room. The patients were randomized into two groups: Group I: consisted of patients
      were subjected to delorme operation only. Group II: consisted of patients were subjected to
      delorme operation with post anal repair and levatorplasty.
    

Intervention name(s): Group I: delorme operation only.; delorme operation with post anal repair
Intervention type(s): Procedure; Procedure
Intervention description(s): A circumferential incision was made in the rectal mucosa approximately 1 cm away from the dentate line. Using electrocautery, the mucosa was stripped to the apex of the prolapse. The muscular layers of the rectal wall were reduced as the mucosa was stripped. Mucosal stripping continued past the apex of the prolapse and then continued inside the prolapsed segment to a point internally that is equivalent to the point of the initial mucosal incision. The underling muscle was plicated by vicryl 2/0.The muscle bite was taken longitudinally from 8 sides to reach a horizontal line of plication at the end. The mucosa was then reanastomosed.; In group II : post anal repair was added by making transverse incision 7cm behind the anal canal.dissection of intersphincteric plain,plication of internal sphincter by using 3/0 vicryl.The levator ani and external sphincter were then sutured to each other by vicryl 2/0 behind the anal canal followed by skin closure without drain.
Other intervention name(s): Group I; Group II
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Delorme operation,incontinence