Mucosal Sleeve Procedure

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Unlike many other operations for prolapse that were performed at the beginning of the 20th century, the mucosal sleeve resection, originally

Figure 20.5. Resection of mucosal sleeve and plication of the rectal wall (Delorme procedure). This operation involves a total mucosal stripping of the prolapsed segment and its plication in an accordion-like fashion by a series of stitches. From Karulf RE,Madoff RD,Goldberg SM. Rectal prolapse. Curr Probl Surg 2001;38:771-832, with permission from Elsevier.

Figure 20.5. Resection of mucosal sleeve and plication of the rectal wall (Delorme procedure). This operation involves a total mucosal stripping of the prolapsed segment and its plication in an accordion-like fashion by a series of stitches. From Karulf RE,Madoff RD,Goldberg SM. Rectal prolapse. Curr Probl Surg 2001;38:771-832, with permission from Elsevier.

described by Delorme22 in 1900, is still performed today (Fig. 20.5). The procedure includes a stripping of the mucosa of the prolapsed rectum and sutured plication of the remnant bare muscle, collapsing the wall like an accordion. The mucosa is then reapproximated to seal the anastomosis.

The main advantage of the Delorme procedure is its minimal physiologic impact. The lack of an abdominal incision and avoidance of the peritoneal cavity are key factors. It can be performed under local anesthesia, if needed, on even the highest risk patients. It is ideal for a low or a small prolapse. Frail or elderly patients with a limited life expectancy, who have a symptomatic rectal prolapse, are best suited to this procedure.

There are many disadvantages of the mucosal sleeve procedure. The procedure requires a dissection of the mucosa from the muscle wall. More importantly, the procedure does not fix the rectum to the sacrum or repair the pelvic floor, and the pleated muscle at the anal verge provides a false sense of security when considering the potential for recurrence. Even in favorable series, the recurrence rate for mucosal sleeve resection is higher than the rate for most contemporary abdominal procedures or rectosigmoidectomy. While a focus on patient selection may improve the results,23 selection criteria alone are not the answer. Patients who are seeking a durable repair for rectal prolapse should look elsewhere for a solution.

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