A 78-year-old woman with severe cardiac failure and COPD presents with recurrent full-thickness circumferential rectal prolapse. Which operative approach is most appropriate?
- A Abdominal sutured rectopexy with mesh
- B Delorme's perineal mucosal sleeve resection and plication ✓
- C Laparoscopic ventral rectopexy under general anesthesia
- D Anterior resection with stapled anastomosis
Correct answer: B. Delorme's perineal mucosal sleeve resection and plication
Explanation
Delorme's procedure is a perineal operation that can be done under regional or local anesthesia, making it suitable for frail, elderly or high-risk patients with full-thickness rectal prolapse. It involves stripping the mucosa from the prolapsed cylinder and plicating the muscular layer. Abdominal rectopexy, whether open or laparoscopic, offers lower recurrence in fit patients but requires general anesthesia and pneumoperitoneum, which this patient's cardiac and respiratory disease makes unsafe.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.