Delorme Procedure for Rectal Prolapse Presenting with Vaginal Prolapse Objectives Review rectal prolapse as it relates to your gynecologist. Discuss the advantages of the Delorme's procedure for repair of rectal prolapse. Describe the Delorme's procedure step by step. Rectal prolapse is a full thickness extension of the rectal wall beyond the anal verge. Like all pelvic floor disorders, rectal prolapse is more common in women than men, particularly those with increased parity, pelvic floor compromise, or obstetric trauma. It is also more common in patients with chronic constipation. Women will often present to your gynecologist with symptoms of vaginal prolapse Rectocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and 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Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele Rectocele and or Enterocele The proximal and distal mucosal edges are then approximated using large sutures evenly placed around the rectum. The mucosal edges are then brought together with small suture to cover any defect. To begin, an anal block is performed with 0.25% Marcane with epinephrine. The perianal skin is infiltrated circumferentially. A lone star retractor is then used to evert the anal verge. Using Babcock clamps, the rectum is maximally prolapsed. A submucosal injection of 0.25% Marcane with epinephrine is then performed circumferentially at approximately 1.5 cm from the dentate line. A mucosal flap is then elevated using needle tip cautery, taking care to preserve the underlying muscularis layer. The mucosal sleeve is dissected down to a length of 15 cm, where it begins to taper and more normal appearing rectum is encountered. The mucosal sleeve is dissected down to a length of 15 cm, where it begins to taper and more normal appearing rectum is encountered. The mucosal sleeve is dissected down to a length of 15 cm, where it begins to taper and more normal appearing rectum is encountered. When dissection is complete, the mucosal sleeve is then transected and removed from the field. The muscularis is then placated circumferentially with two OPDS sutures, 10 times starting at the 12 o'clock, 3 o'clock, 6 o'clock, and 9 o'clock positions, and then placing additional sutures equidistant between these initial sutures. Once placed, the PDS sutures are tied down to adequately placate the muscularis layer. The distal rectal mucosa is then re-approximated to the dentate line with interrupted two ovicral sutures. Care is then given to the mucosal sleeve and the mucosal sleeve is placed at the 12 o'clock, 6 o'clock position. Care is taken to imbricate these sutures and include some of the underlying muscularis layer. The long star retractor is then removed and the rectum is easily reduced into the pelvic inlet. A rigid proctoscopy is then performed to ensure the filament is patent and the mucosa is healthy.

Delorme procedure

rectal prolapse

women

pelvic floor issues

chronic constipation