A 79-year-old woman with severe cardiac failure (ASA class III) presents with a full-thickness rectal prolapse protruding 6 cm through the anus, reducible manually but recurring constantly. Which operation is most appropriate?

• A Abdominal suture rectopexy with mesh
• B Anterior resection with rectopexy
• C Delorme's perineal procedure ✓
• D Thiersch anal encircling procedure as definitive repair

Explanation

Delorme's operation, a perineal mucosal sleeve resection with muscular plication, avoids a laparotomy and general anaesthetic burden, making it ideal for elderly or unfit patients with full-thickness prolapse. Abdominal rectopexy gives better functional results and lower recurrence but demands fitness for major abdominal surgery, which this patient lacks. The Thiersch encirclement is a temporising measure reserved for the extremely frail and carries high rates of erosion and recurrence.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.