The Delorme’s procedure is used for the repair of full-thickness rectal prolapse via the perineal approach. It is normally reserved for older, frail patients with significant comorbidity. This study investigates the surgical and patient-reported outcomes of Delorme’s procedure, with the primary aim of understanding postoperative patient regret.

Data were collected retrospectively for patients who underwent a Delorme’s procedure for full-thickness rectal prolapse. These were either diagnosed clinically or during defaecation proctography between 2014 and 2025. Patient demographics and baseline clinical variables were obtained from electronic records. Postoperative symptoms examined included faecal incontinence, incomplete emptying and recurrence of rectal prolapse. Patients were interviewed about changes in quality of life before and after the surgery using a 10-point Likert scale. Decisional regret was assessed using the Ottawa Decision Regret Scale (ODRS). ODRS results can indicate the presence of regret, and scores can be grouped into three regret categories: no, mild, and moderate-to-severe.

22 patients underwent Delorme’s procedure, with a mean age of 71.6 years (range: 33-93). Eight (36.4%) had a prior rectal prolapse repair. 18/22 (81.8%) presented with a low take-off rectal prolapse, and the remaining (4/22, 18.2%) presented with a high take-off rectal prolapse. 3 patients (13.6%) presented concomitantly with a rectocele, whilst 4 (18.2%) presented concomitantly with an enterocele. Patients were followed up for a median of 51 months (range: 2-146). Two patients (9.1%) had a recurrence, one was diagnosed clinically, and the other during defaecation proctogram. For postoperative symptoms, eight patients (36.4%) reported faecal incontinence, and 5 patients (22.7%) reported incomplete emptying after surgery. 

Thirteen patients (59.1%) were interviewed and completed the ODRS. Nine patients (9/22, 40.9%) were not contactable and did not complete the phone interview.  5 patients (5/13, 38.5%) expressed no regret, whilst 8 patients (8/13, 61.5%) expressed regret. In the regret severity categories, 5 patients (38.5%) expressed no regret, whilst 7 patients (53.8%) expressed mild regret, and one with moderate regret (7.7%). 11 patients (84.6%) expressed improvement in quality of life after operation, with 2 (15.4%) stating that it remained the same. No association was found between regret and baseline characteristics, postoperative symptoms, or recurrence. No association was found between the regret categories, baseline characteristics, and postoperative symptoms. The association between regret categories and recurrence was not analysed due to insufficient numbers of patients in each category.

These findings highlight an important and somewhat paradoxical pattern in patient-reported outcomes following Delorme’s procedure. Despite a favourable recurrence rate (2/22, 9.1%) and most patients reporting improvement in quality of life (11/13, 84.6%), over half expressed some degree of regret following surgery (8/13, 61.5%). The high rate of postoperative faecal incontinence (36.4%) can be a contributing factor, as this represents a significant and potentially unexpected burden that can shape a patient’s retrospective appraisal of their decision to proceed with surgery. Notably, the absence of a statistically significant association between regret and postoperative symptoms or recurrence suggests that regret is likely multifactorial. Furthermore, the smaller sample size limits the statistical power and limits meaningful subgroup analyses, as evidence by the inability to examine the association between regret categories and recurrence.

Delorme’s procedure can be performed with a low recurrence rate (9.1%). Patient-reported outcomes showed a high rate of regret after surgery (61.5%), but interestingly, 84% reported an improvement in quality of life. There was a high proportion of patients who suffered from faecal incontinence post-operatively. Future qualitative work is required to understand the reasons behind the regret felt, as well as the perceived improvement in quality of life. Understanding patients' regret helps us towards shared decision-making when considering the management of rectal prolapse.