Rectal Prolapse Recurrence After Delorme Procedure: Experiences from a Combined Pelvic Floor Clinic

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Rectal prolapse is a debilitating disorder, most commonly affecting women in their sixth and seventh decades of life. The disorder is thought to relate to multiparity and pelvic floor dysfunction, often coinciding with prolapse of other pelvic organs, however, our understanding of the pathophysiology of the disease remains incomplete. Traditionally we perform a perineal approach for patients with frailty, advanced age, or the desire to avoid abdominal surgery. Since 2017, we have started to treat pelvic organ prolapse and rectal prolapse with concurrent operations in tandem with urogynecology.

We performed a retrospective review of 44 patients who underwent consecutive Delorme procedures at one center, 18 of whom underwent concurrent gynecologic pelvic floor reconstruction. All patients > 18 years old were included between 2016 and 2025. Demographic characteristics, ASA, BMI, obstetric history, connective tissue disorders, smoking history, and previous pelvic floor repair were gathered to characterize patients. Cleveland Clinic fecal incontinence and colorectal-anal impact questionnaire scores were gathered pre- and post-operatively to assess symptom resolution. Our primary outcome was recurrence, with secondary outcomes being time to recurrence and recurrence with concurrent gynecologic procedure.

Of the 44 patients (all female), the mean age was 80.2 (range 52- 99), the median ASA was 3, and the mean number of deliveries was 3.1 (range 0-11). 59% had previously undergone hysterectomy, and 48% had undergone a prior pelvic floor surgery. Postoperative incontinence scores showed a nonsignificant improvement (11 to 9, p= 0.24) while colorectal specific quality of life significantly improved (11 to 5, p < 0.001). Overall recurrence was 25% (n=11) and 3 patients suffered more than one recurrence (7%). Of the 18 patients who underwent a concurrent gynecologic procedure, 4 recurred (22%). Mean time to recurrence was 13.6 months (range 1-27 months). Recurrences were treated with a combination of abdominal and perineal approaches. While 30% (n=13) had an early complication, the most common was transient urinary retention. Only 1 patient required a repeat procedure for rectal bleeding.

The Delorme procedure was well tolerated amongst our cohort of those with advanced age and frailty. Recurrence of 25% is in line with other published recurrence rates of all types of prolapse repair. In patients with pelvic organ and rectal prolapse, concurrent gynecologic procedure, did not decrease the rate of recurrence, but all patients who underwent Delorme procedure showed improvement in objective measures of symptom burden.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1914

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