Concierge colorectal surgery · London
Delorme’s procedure for full-thickness rectal prolapse, a perineal repair.
A patient guide to Delorme’s procedure — how it works, who it suits, how it compares with abdominal ventral rectopexy and Altemeier, and what recovery looks like.
Why patients choose us
- 01
A colorectal surgeon with a pelvic-floor subspecialty
Rectal prolapse is a pelvic-floor problem as much as a surgical one. Your named surgeon operates in this field week in, week out.
- 02
The abdominal option honestly weighed
Delorme’s is a perineal repair — it suits frailer patients. If a ventral mesh rectopexy is the better answer, we say so first.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private rectal-prolapse surgery costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across the perineal and abdominal options.
In short
A Delorme’s procedure in our network: £6,500–£10,500, typically 1–3 nights in hospital.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Colorectal surgeon consultation | £250–£450 | 30–45 min | Same visit |
| MR defecography | £800–£1,400 | 30–45 min | 3–5 working days |
| Anorectal physiology tests | £400–£800 | 45 min | 1–2 weeks |
| Delorme’s procedure (perineal) | £6,500–£10,500 | 60–90 min | 1–3 night stay |
| Altemeier perineal proctosigmoidectomy | £8,000–£12,500 | 90–120 min | 2–4 night stay |
| Ventral mesh rectopexy (abdominal) | £11,000–£16,000 | 2–3 hr | 3–5 night stay |
Prices vary by clinic, by which colorectal surgeon does the case, by the anaesthetic chosen, and by length of hospital stay. We come back with a firm quote within one working day.
The problem
The right operation, at the right altitude of surgery.
Full-thickness rectal prolapse is often over-treated with the wrong operation — a perineal repair for a patient who could have had a definitive abdominal one, or an abdominal repair for someone who cannot tolerate it. The choice matters.
-
Frail and in your eighties?
A perineal Delorme’s or Altemeier avoids the pneumoperitoneum and long GA of an abdominal repair.
-
Fit and in your sixties?
A ventral mesh rectopexy usually gives lower recurrence and better function. We say so before booking a perineal case.
-
Uncertain diagnosis?
A defecating proctogram or MR defecography sorts full-thickness prolapse from internal intussusception before you commit to surgery.
The journey
From assessment to rehab — what happens, in order.
One colorectal surgeon from first message to review — including the pelvic-floor rehabilitation afterwards.
Phase 1 · Before your procedure
Assessment and imaging
Phase 2 · Admission
A short hospital stay
Phase 3 · After
Pelvic-floor rehab
- 01
Before
You tell us what is going on
A short, confidential form. How long the prolapse has been coming down, bowel habit, continence, previous surgery.
- 02
Before
Assessment with a colorectal surgeon
Examination in clinic, often with a rigid sigmoidoscopy. A defecating proctogram or MR defecography is usually arranged to confirm full-thickness prolapse and rule out intussusception.
- 03
Before
The decision — perineal or abdominal
Delorme’s versus Altemeier versus a ventral mesh rectopexy. The right answer depends on age, fitness, prior surgery and the anatomy on imaging.
- 04
Admission
Admission and anaesthetic
Spinal or general anaesthetic in a licensed theatre. Bowel preparation and antibiotics on the day.
- 05
Admission
The Delorme’s procedure
A perineal (transanal) operation. The redundant rectal mucosa is stripped off the prolapsed segment, the muscular wall is plicated, and the mucosa is reattached in a shortened sleeve — 60–90 minutes.
- 06
Admission
Ward recovery
Usually one to three nights in hospital. Diet reintroduced early, laxatives to keep stools soft, and a plan for the first bowel motion before you go home.
- 07
After
Pelvic-floor rehab and review
Bowel-function programme, pelvic-floor physiotherapy and biofeedback where indicated. Surgical review at six weeks; longer-term monitoring for recurrence.
Typical end-to-end: 3–5 weeks from enquiry to procedure. Pelvic-floor rehab: 3–6 months.
When it helps
When Delorme’s procedure is the right operation.
The situations where a perineal repair is chosen over an abdominal one — plus the red flag that means emergency care rather than a clinic booking.
-
Full-thickness rectal prolapse
A visible cylinder of rectum coming down through the anus, especially when abdominal surgery is best avoided.
-
Older or frail patients
A perineal repair spares an abdominal incision and general anaesthetic when cardiac or respiratory reserve is limited.
-
Cardiorespiratory comorbidity
Significant heart or lung disease that makes a lengthy abdominal operation and pneumoperitoneum unwise.
-
Extensive previous abdominal surgery
Dense adhesions or hostile abdomen where a laparoscopic ventral rectopexy carries a higher complication load.
-
Solitary rectal ulcer syndrome
Selected cases of SRUS with associated internal prolapse where a perineal mucosal resection is appropriate.
-
Incarcerated prolapse — selected
An emergency prolapse that cannot be reduced, in a patient unfit for an abdominal approach, may be managed by Delorme’s.
-
Patient preference against mesh
For people who decline synthetic mesh or biologic implants, a perineal repair is the mesh-free option.
-
Red flag: bleeding, obstruction, pain
A prolapse that is bleeding heavily, cannot be reduced or is causing severe pain is an emergency — A&E, not a clinic booking.
Treatment options
Delorme’s is not the only operation.
What each option on the table actually involves — and which fits which patient.
-
Delorme’s procedure
Perineal mucosal stripping and muscular plication. Lower physiological hit, recurrence 10–30% at five years.
-
Altemeier procedure
Perineal proctosigmoidectomy — the prolapsed segment is resected and a coloanal anastomosis fashioned. Suits longer prolapses.
-
Ventral mesh rectopexy
Laparoscopic or robotic abdominal repair with a mesh sling. Gold standard for fit patients; lowest recurrence rates.
-
Suture rectopexy
Abdominal fixation of the rectum to the sacrum without mesh — an option where mesh is declined but abdominal surgery is tolerated.
-
Thiersch anal encirclement
A palliative silicone or mesh sling around the anus for very frail patients unfit for any resection.
-
Conservative management
Bulking agents, laxatives, pelvic-floor physio and biofeedback. Not curative for full-thickness prolapse but helpful before or alongside surgery.
-
Pelvic-floor rehabilitation
Structured programme of physiotherapy and biofeedback either as prehab or after surgery to protect continence.
-
Consultation only
An honest discussion of whether surgery is needed at all, and which approach fits — no obligation.
Our vetted London network
A small panel of colorectal surgeons, we picked them.
Consultant colorectal surgeons with a pelvic-floor subspecialty across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every colorectal surgeon in our network.
-
Consultant colorectal surgeons with a pelvic-floor subspecialty
-
Access to MR defecography and anorectal physiology on site
-
Both perineal (Delorme, Altemeier) and abdominal (ventral rectopexy) options offered
-
Pelvic-floor physiotherapy and biofeedback available for pre- and post-op rehab
Safety and recovery
What to expect afterwards — honestly.
Delorme’s is a safe operation in experienced hands, but functional outcomes are variable and recurrence is a real trade-off of choosing the perineal route. Here is the honest picture.
-
Recurrence — the honest number
Full-thickness prolapse comes back in 10–30% of patients within five years after Delorme’s. That is higher than a ventral rectopexy, and part of why the abdominal option is preferred when a patient can tolerate it.
-
Bleeding
Some bleeding from the mucosal stripping is expected. Significant haemorrhage needing return to theatre is uncommon but reported.
-
Continence changes
Continence often improves as the prolapse is corrected, but new-onset incontinence, urgency or frequency can occur — pelvic-floor rehab addresses this.
-
Anastomotic breakdown
Separation of the reattached mucosa is rare but serious. It usually presents as pain, fever or bleeding in the first week.
-
Wound infection
Perineal wound infection is uncommon in a properly prepared bowel — antibiotics are given at induction.
-
DVT and PE
Any pelvic operation carries a venous thromboembolism risk. Prophylactic heparin and early mobilisation are standard.
-
Missed sigmoid intussusception
Imaging before surgery matters. If a high sigmoid intussusception is missed, a perineal repair alone may leave symptoms unresolved.
-
Need for redo — abdominal after failed perineal
A recurrence after Delorme’s often means a second operation, sometimes an abdominal one. This is a real trade-off of choosing the perineal route first.
-
Red flags
Fever, spreading pain, heavy bleeding, calf swelling, breathlessness, chest pain or sexual dysfunction after surgery need same-day medical review.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever approach was used, the note the colorectal surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and approach chosen
Why a perineal Delorme’s was chosen over an abdominal repair — age, fitness, prior surgery, imaging findings.
- 02 Technique
Anaesthetic and operative technique
Spinal or GA, length of mucosal sleeve stripped, number of plicating sutures, integrity of the coloanal reattachment.
- 03 Findings
Prolapse length, sphincter, intussusception
Length of prolapse reduced, sphincter tone, and whether any internal (sigmoid) intussusception was seen.
- 04 Impression
Recovery, bowel-function plan, review
Read this first: laxative regimen, pelvic-floor rehab pathway, when to return to activity and when to be reviewed.
Recognised by major UK insurers
Cover for rectal-prolapse surgery is usually funded when medically indicated. Codes and pre-authorisation vary by insurer — we confirm cover before booking.
Frequently asked
Everything we get asked about Delorme’s procedure.
Quick answers on how it works, how it compares with Altemeier and ventral rectopexy, and what recovery looks like.
-
What is Delorme’s procedure?
A perineal operation for full-thickness rectal prolapse. The surgeon works through the anus, strips the redundant mucosa off the prolapsed rectum, folds the muscular wall on itself with sutures (plication), and reattaches the mucosa to form a shortened sleeve. It is done without an abdominal incision.
-
Who is Delorme’s procedure suitable for?
Mainly older or frail patients with full-thickness rectal prolapse who are unsuitable for an abdominal ventral mesh rectopexy — because of age, cardiac or respiratory disease, or extensive previous abdominal surgery. It is also used for selected cases of solitary rectal ulcer syndrome and, occasionally, incarcerated prolapse.
-
How does Delorme’s compare with ventral mesh rectopexy?
Ventral mesh rectopexy is the gold standard for fit patients — lower recurrence, better functional outcomes, but a laparoscopic abdominal operation with mesh. Delorme’s is less physiologically demanding but recurrence is higher (10–30% at five years). The choice is about fitness and preference, not surgeon convenience.
-
What are the alternatives?
Altemeier perineal proctosigmoidectomy (resection rather than plication), abdominal ventral mesh rectopexy, suture rectopexy without mesh, or Thiersch anal encirclement as a palliative option. Conservative pelvic-floor rehabilitation helps symptoms but does not cure a full-thickness prolapse.
-
What is recovery like?
A one to three night hospital stay, laxatives to keep stools soft, and pelvic-floor physiotherapy over the following weeks. Most patients are back to light activity in two to three weeks and full activity by six. The bowel-function programme continues for months.
-
What are the main complications?
Recurrence of the prolapse, bleeding, new or worsening faecal incontinence and urgency, anastomotic breakdown, wound infection, DVT or PE, and — rarely — the need for a second, abdominal operation if the perineal repair fails.
Sources and further reading
- Association of Coloproctology of Great Britain and Ireland (ACPGBI). Pelvic Floor guidelines.
- European Society of Coloproctology (ESCP). Guidelines on the management of rectal prolapse.
- American Society of Colon and Rectal Surgeons (ASCRS). Clinical practice guidelines for rectal prolapse.
- Royal College of Surgeons of England. Commissioning guide: rectal prolapse.
Last reviewed 2026-07-30 · Next review 2027-07-30 · ~6 min read
Related tests
Looking for something else?
-
Anorectal physiology tests
Sphincter pressures, sensation and rectoanal reflexes.
Learn more -
Colorectal physiology tests
Full pelvic-floor and bowel-function work-up.
Learn more -
Rigid sigmoidoscopy
Clinic examination of the rectum and lower sigmoid.
Learn more -
All tests
Every test and procedure we arrange.
Learn more