Delorme procedure: what to expect

At a glance

The Delorme procedure is a perineal surgical technique for rectal prolapse — meaning the entire procedure is performed through the anus without any abdominal incisions. It is most commonly used for shorter prolapse and in people who may not tolerate abdominal surgery well.

The procedure involves stripping the inner lining of the prolapsed rectum, folding the exposed muscle layer to tighten and shorten the rectum, and reattaching the lining. The result is a firmer, less prolapse-prone rectum.

How the procedure works

The technique

1. The prolapse is brought down — the prolapsed tissue is gently everted
2. Mucosal stripping — the inner lining (mucosa) of the prolapsed section is carefully separated from the underlying muscle
3. Muscle plication — the exposed muscle layer is folded and stitched with multiple sutures, shortening and tightening it
4. Mucosal reconnection — the remaining mucosal edges are sutured together
5. Result — the rectum is shorter, tighter, and less prone to prolapsing

The procedure is performed under general or spinal anaesthesia and typically takes one to two hours.

Why it works

The plication of the muscle layer creates a thicker, firmer rectal wall. This tightening reduces the laxity that allowed the prolapse to occur. The shortened rectum has less tissue available to fold and prolapse through the anus.

Who it is suitable for

Commonly recommended for

• Older adults who may carry higher risk with abdominal surgery
• People with significant medical conditions that make abdominal approaches riskier
• Shorter prolapse — the technique works best when the prolapse length is moderate
• Mucosal prolapse — where only the inner lining prolapses rather than the full thickness of the rectal wall
• People who prefer a less invasive approach — with understanding of the trade-offs

Less suitable for

• Very large full-thickness prolapse — may be better addressed with an abdominal approach
• Younger, fit patients — who may benefit from the lower recurrence rates of abdominal rectopexy
• Significant pelvic floor dysfunction — which may need to be addressed concurrently

Recovery

Hospital stay (days 1 to 3)

• Pain is typically mild — paracetamol and standard relief are usually sufficient
• Bowel function is monitored before discharge
• Mobility is encouraged from day one
• Diet returns to normal quickly

Weeks 1 to 2

• Mild discomfort around the anus
• Bowel function may be irregular — looser stools, mild urgency, mucus discharge
• Avoid straining — stool softeners are commonly prescribed
• Light activities and walking are fine
• Avoid heavy lifting

Weeks 2 to 4

• Most people return to normal activities
• Bowel function continues to settle
• Follow-up appointment to assess the result
• Any residual mucus discharge typically resolves

Long term

• The prolapse should be resolved or significantly improved
• Recurrence is possible and monitoring for this is part of ongoing care
• Pelvic floor exercises may be recommended to support the repair
• Regular follow-up in the first year

Recurrence

The Delorme procedure has a higher recurrence rate than abdominal approaches — this is the main trade-off for its lower surgical risk. If the prolapse recurs:

• A repeat Delorme procedure is possible in some cases
• An abdominal approach (rectopexy) may be considered if the person’s fitness allows
• Ongoing pelvic floor rehabilitation can help support the repair

The decision to proceed with Delorme typically involves accepting this trade-off — a less invasive procedure with lower immediate risk but a higher chance of needing further treatment in the future.

Compared to other approaches

Your surgeon will recommend the approach most suitable for your prolapse type, overall health, and individual anatomy.