Full-thickness rectal prolapse can be repaired using various surgical techniques, with ventral mesh rectopexy (VMR) and Delorme’s procedures among the most commonly performed. Although both approaches are well established, comparative evidence on postoperative outcomes and the extent to which these influence patient decision regret remains limited, particularly in older adults. This study examined regret severity, postoperative symptoms and recurrence in patients aged over 70 who underwent a VMR or Delorme’s procedure for full-thickness rectal prolapse.

Patients aged ≥70 who underwent VMR or Delorme’s procedure for full-thickness rectal prolapse were identified via electronic records between 2014 to 2025. Baseline characteristics, operative details, recurrence and postoperative symptoms were extracted. Postoperative symptoms examined included faecal incontinence and incomplete emptying. 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). The ODRS results can show the presence of regret, and the scores can be grouped into three regret categories: no, mild and moderate-to-severe regret.

Thirty-two patients were included: 23 had a VMR (71.9%), whilst 9 had a Delorme’s procedure (28.1%). High take‑off prolapse was more common in the VMR group (82.6%), while low take‑off prolapse predominated in Delorme’s group (77.8%, p=.003). 

For the VMR, 18 patients (78.3%) reported no regret, and 5 (21.7%) reported regret. Looking at regret severity groups within the VMR cohort, 18 patients (78.3%) reported no regret, 4 (17.4%) reported mild regret, and 1 (4.3%) reported moderate-to-severe regret. 
For the Delorme’s, 3 patients (33.3%) reported no regret, and 6 (66.7%) reported regret after the procedure.  3 patients (33.3%) reported no regret, 5 (55.6%) reported mild regret, and 1 (11.1%) reported moderate to severe regret. 

Overall, regret was significantly more frequently reported (66.7% vs 21.7%, p=.035) in Delorme’s group than in the VMR. Higher levels of regret were also associated with Delorme’s group compared to the VMR (mild regret: 55.6% vs 17.4%; moderate-to-severe regret: 11.1% vs 4.3%, p=.039). Within the VMR group, those with postoperative faecal incontinence were more likely to express regret than those without (50% vs 6.7%; OR 14.0, CI 1.2-163.4, p=.033).  No association was found between regret and postoperative recurrence or incomplete emptying in the VMR group. No association was found between regret and postoperative recurrence, incomplete emptying or faecal incontinence in Delorme’s group.

The significantly higher rates of regret observed in the Delorme’s group likely reflect the well-documented higher recurrence rates associated with this procedure, which may lead patients to question their surgical decision in retrospect. This is further supported by the regret severity, with mild and moderate-to-severe regret both more prevalent in the Delorme’s cohort. Postoperative faecal incontinence was a strong predictor of regret within the VMR cohort, suggesting that functional deterioration following surgery can meaningfully undermine a patient’s perception of success, regardless of anatomical repair. These results suggest that neither procedure is without potential for regret, and the drivers of that regret differ between the two groups.

Amongst older adults undergoing surgery for full-thickness rectal prolapse, the Delorme procedure was associated with higher reports and higher levels of regret compared with the VMR. However, with the VMR patients, postoperative faecal incontinence appeared to contribute to regret. These findings highlight the importance of procedure selection, preoperative counselling and postoperative expectations in optimising patient satisfaction.