Modified Delorm procedure for surgical treatment of rectal prolapse in children with anorectal malformations

Relevance. Rectal prolapse (RP) is one of the most frequent complications after correction of anorectal malformations (ARM), occurring in 15–40% of children and significantly impairing patients’ quality of life. In this patient population, the classic Delorme procedure often yields suboptimal outcomes: recurrence rates reach 25–35%, and continence function remains poor. This is attributable to the inherently abnormal pelvic floor anatomy and neuromuscular dysfunction of the anorectal region in ARM children.

Aim: to evaluate the efficacy and safety of a modified Delorme procedure, developed at the Research Institute of Pediatric Surgery, National Medical Research Center for Children’s Health, in children with rectal prolapse following correction of anorectal malformations.

Materials and methods. We conducted a prospective analysis of outcomes after the odified Delorme procedure in thirty two patients aged of 4 to 14 years with full-thickness rectal prolapse of grade III–IV according to the Altemeier classification. All patients had a history of surgical correction of various types of ARM. Among them, 8 patients had recurrent prolapse after unsuccessful prior operations. The modified technique included a gentle circumferential mucosectomy with preservation of the submucosal vascular plexus, multilevel three-stage plication of the muscular layer, formation of a muscular cuff with additional fixation to pelvic floor structures, and creation of a submucosal bulwark. The postoperative follow-up period was up to 10 months.

Results. The mean operative time was 82 ± 15 min. Postoperative complications (anal canal stenosis) occurred in 3 patients, compared to 20–35% reported in the literature for the classic technique. Functional outcomes showed a marked improvement in continence scores from a baseline of 3.4 ± 1.1 to 8.1 ± 1.3 ball at 6 months on the Krickenbeck scale, versus 6.2 ± 1.4 ball for the classic Delorme procedure. During the follow-up of up to 10 months, no recurrences of rectal prolapse were observed in any patient, compared to 10–17% within the first year with the classic technique.

Conclusion. Preliminary results demonstrate high efficacy and safety of the modified Delorme procedure in children with rectal prolapse after ARM correction. The method shows significant advantages over the classic technique and may be recommended for the use in specialized centers. Further research is required to assess long-term outcomes.

Contribution:
Gusev A.A., Okulov E.A. — study concept and design;
Gusev A.A., Okulov E.A., Khvorostov I.N., Dyakonova E.Yu., Shchukina A.A., Bekin A.S., Romanova E.A., Tarzyan A.O., Evgenova N.N., Myagkov A.E. — data collection and surgical treatment;
Gusev A.A. — data analysis and statistical processing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: September 15, 2025
Accepted: October 02, 2025
Published: October 30, 2025

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