An 80-year-old woman with severe heart failure (ASA class IV) presents with a complete circumferential full-thickness rectal prolapse protruding 6 cm, reducible manually. She is deemed high risk for major abdominal surgery. Which operation is most appropriate?

• A Laparoscopic ventral mesh rectopexy
• B Delorme's perineal mucosal sleeve resection ✓
• C Open abdominal sutured rectopexy with sigmoid resection
• D Rubber band ligation of the prolapsed mucosa

Explanation

Perineal operations avoid general anaesthesia and laparotomy, making them the choice for elderly or medically unfit patients with full-thickness prolapse. Delorme's procedure strips the mucosa and plicates the muscular layer, while Altemeier's perineal proctosigmoidectomy suits larger prolapses. Abdominal rectopexy, whether open or laparoscopic, offers the lowest recurrence but carries operative risk unacceptable in ASA IV patients. Rubber banding treats haemorrhoids or mucosal prolapse only.

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.