A 76-year-old frail woman presents with full thickness rectal prolapse protruding through the anus, with incontinence. She is assessed as high risk for major laparotomy and laparoscopy. Which operative approach is most appropriate?

• A Abdominal suture rectopexy with mesh (Ripstein)
• B Delorme's mucosal sleeve resection and plication via the perineum ✓
• C Laparoscopic ventral mesh rectopexy
• D Altemeier's procedure combined with immediate mesh reinforcement

Explanation

For elderly or comorbid patients unfit for an abdominal operation, a perineal approach is chosen. Delorme's procedure (circumferential mucosal sleeve resection with muscular plication) is well tolerated, avoids abdominal access, though recurrence rates exceed those of abdominal rectopexy. Altemeier's perineal proctosigmoidectomy is an alternative but carries higher anastomotic leak risk in frail patients. Abdominal rectopexy, whether open sutured or laparoscopic ventral mesh, gives lower recurrence but is inappropriate here given her fitness status.

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

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Written and medically reviewed by the StethoPrep medical team.