EP735 - Robotic Management of Recurrent Rectal Prolapse

Purpose/Background: Recurrent rectal prolapse can be challenging to manage, and strong guidelines for best practice do not exist. There is, however, consensus that an abdominal approach is preferable when addressing recurrence. This study therefore describes the abdominal robotic management of recurrent rectal prolapse at a single-center institution.

Methods/Interventions: Adults undergoing robotic surgery for rectal prolapse were identified using CPT codes ascribed between January 2012 and July 2025. A retrospective review of patients subsequently identified those undergoing surgery for recurrent prolapse, after which key variables were recorded. Descriptive statistics and chi-squared tests were performed for analysis.

Results/Outcomes: Forty-six patients met inclusion criteria. Median age at the time of surgery for recurrence was 66.1 years (IQR 50.2-72.4). Most were female (89.1%, n=41), and 93.5% (n=43) were white. Median body mass index (BMI) was 25.9 (IQR 22.4-30.3). A connective tissue disorder was diagnosed in 17.4% (n=8) of patients. Most were undergoing their first surgery for recurrent prolapse (69.6%, n=32), followed by 23.9% (n=11) with re-recurrence, and lastly 6.5% (n=3) for whom this was their third operation for recurrence. Ventral rectopexy was the most common modality of initial prolapse treatment (39.1%, n=18), followed by suture rectopexy (21.7%, n=10), resection rectopexy (17.4% (n=8), perineal procedures (17.4%, n=8), and dorsal mesh rectopexy (4.3%, n=2). Median time to recurrence of prolapse symptoms was less than a year (11 months, IQR 3.4-32.8). Recurrent prolapses were treated with an escalation of care: a different approach or the addition of technical adjuncts. Ventral rectopexy was the most commonly performed operation (80.5%, n=37), followed by dorsal mesh rectopexy (n=6, 13.0%), and suture rectopexy (n=3, 6.5%). Concurrent procedures for other pelvic organ prolapse were performed in 43.5% (n=20). Median blood loss was low (50 mL, IQR 10-100), and length of stay (LOS) generally 1 day or less. 90-day unplanned readmission rate was 4.3% (n=2), and severe complications (Clavien Dindo ≥3a) occurred in 2.2% (n=1). With a median follow-up time of 1 year (IQR 5.4 months-35.5), re-recurrence requiring an additional operation for prolapse was noted in 10.9% (n=5). Median time to re-recurrence of symptoms was 2.6 months (IQR 2.0-3.0). Three patients (6.5%) had recurrent mucosal-only prolapse managed with sutured transanal mucosectomy and plication, and two (4.3%) had full-thickness prolapse managed with ventral rectopexy. Re-recurrence requiring an additional operation was associated with suture-only repairs of recurrent prolapse (p=0.001). There was no difference in re-recurrence based on number of prior prolapse operations (p=0.78).

Conclusion/Discussion: Robotic surgery for recurrent rectal prolapse is feasible and safe with careful patient selection at high-volume centers. Re-recurrence rates of prolapse do not appear to be greater than the recurrence of primary repairs. Further research should focus on identifying biomechanical, functional, and technical factors to minimize recurrence.