Delorme's vs. Altemeier's in the management of rectal procidentia: systematic review and meta-analysis

Pratik Bhattacharya; Mohammad Iqbal Hussain; Shafquat Zaman; Sophie Randle; Yousaf Tanveer; Nameer Faiz; Diwakar Ryali Sarma; Rajeev Peravali

doi:10.1007/s00423-023-03181-z

Delorme's vs. Altemeier's in the management of rectal procidentia: systematic review and meta-analysis

Langenbecks Arch Surg. 2023 Dec 2;408(1):454. doi: 10.1007/s00423-023-03181-z.

Authors

Pratik Bhattacharya¹, Mohammad Iqbal Hussain², Shafquat Zaman³, Sophie Randle³, Yousaf Tanveer⁴, Nameer Faiz⁵, Diwakar Ryali Sarma³, Rajeev Peravali³

Affiliations

¹ Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK. pratik.bhattacharya@nhs.net.
² Department of General Surgery, Great Western Hospitals NHS Foundation Trust, Swindon, UK.
³ Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK.
⁴ Department of General Surgery, Craigavon Area Hospital, Portadown, Northern Ireland, UK.
⁵ Department of General Surgery, The Dudley Group NHS Trust, Russells Hall Hospital, Dudley, West Midlands, UK.

PMID: 38041773
DOI: 10.1007/s00423-023-03181-z

Abstract

Background: Rectal prolapse is a distressing condition for patients and no consensus exists on optimal surgical management. We compared outcomes of two common perineal operations (Delorme's and Altemeier's) used in the treatment of rectal prolapse.

Methods: A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme's and Altemeier's procedures were extracted. Primary outcomes included recurrence rate, anastomotic dehiscence rate and mortality rate. The secondary outcomes were total operative time, volume of blood loss, length of hospital stay and coloanal anastomotic stricture formation. Revman 5.3 was used to perform all statistical analysis.

Results: Ten studies with 605 patients were selected; 286 underwent Altemeier's procedure (standalone), 39 had Altemeier's with plasty (perineoplasty or levatoroplasty), and 280 had Delorme's. Recurrence rate [OR: 0.66; 95% CI [0.44-0.99], P = 0.05] was significantly lower and anastomotic dehiscence [RD: 0.05; 95% CI [0.00-0.09], P = 0.03] was significantly higher in the Altemeier's group. However, sub group analysis of Altemeier's with plasty failed to show significant differences in these outcomes compared with the Delorme's procedure. Length of hospital stay was significantly more following an Altemeier's operation compared with Delorme's [MD: 3.05, 95% CI [0.95 - 5.51], P = 0.004]. No significant difference was found in total operative time, intra-operative blood loss, coloanal anastomotic stricture formation and mortality rates between the two approaches.

Conclusions: A direct comparison of two common perineal procedures used in the treatment of rectal prolapse demonstrated that the Altemeier's approach was associated with better outcomes. Future, well-designed high quality RCTs with long-term follow up are needed to corroborate our findings.

Keywords: Altemeier’s; Delorme’s; Rectal prolapse; Rectosigmoidectomy.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Blood Loss, Surgical
Constriction, Pathologic
Digestive System Surgical Procedures* / methods
Humans
Neoplasm Recurrence, Local
Rectal Prolapse* / surgery
Recurrence
Treatment Outcome