V37 - Management of Recurrent Rectal Prolapse Following Robotic Ventral Mesh Rectopexy - Avoiding Re-do Low Pelvic Dissection in a Young Woman

Saturday, May 9, 2026

On-Demand

Video Presentation(s)

Josh Appel, MD, MSc, FRCSC

Fellow
Icahn School of Medicine at Mount Sinai Hospital
Icahn School of Medicine at Mount Sinai
New York, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

JR

Jordan Roy, MD

Research Resident
Icahn School of Medicine at Mount Sinai Hospital
Icahn School of Medicine at Mount Sinai Hospital New York, NY
staten island, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Jared S. Matson, MD

Colon and Rectal Surgery Fellow
Icahn School of Medicine at Mount Sinai
Icahn School of Medicine at Mount Sinai
New York, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Jorge Zarate Rodriguez, MD

Colon and Rectal Surgery Fellow
Icahn School of Medicine at Mt Sinai
Icahn School of Medicine at Mount Sinai
New York, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
DR

Daniela I. Ramos-Delgado, M.D.

Research Resident
Icahn School of Medicine at Mount Sinai Hospital
Hoboken, New Jersey, United States

Disclosure information not submitted.
Katherine W. Lam, MD

Colorectal Surgery Research Fellow
Icahn School of Medicine at Mount Sinai
Westchester Medical Center
New York, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
RM

Roxanne Mistry, BA

Clinical Research Coordinator II
Mount Sinai Hospital
New York, New York, United States

Disclosure information not submitted.
KM

Kate Micallef, B.S.

Research Assistant
Mount Sinai Hospital
New York, New York, United States

Disclosure information not submitted.
Patricia Sylla, MD, FACS, FASCRS (she/her/hers)

System Chief of Colon and Rectal Surgery
Mount Sinai Hospital
Icahn School of Medicine at Mount Sinai
New York, New York, United States

All of the relevant financial relationships listed below have been mitigated.
Activ Surgical: Consultant (Ongoing); Ethicon: Consultant (Ongoing); Medtronic: Consultant (Ongoing); Moon Surgical: Consultant (Ongoing); Safeheal: Consultant (Ongoing); Stryker: Consultant (Ongoing)
AG

Alexander J. Greenstein, MD

Professor of Surgery
Mount Sinai Hospital
New York, New York, United States

Disclosure information not submitted.
Sergey Khaitov, MD

Associate Professor of Surgery
Icahn School of Medicine
New York, New York, United States

Disclosure information not submitted.
Michael C. Plietz, MD (he/him/his)

Assistant Professor of Surgery
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Disclosure information not submitted.
AT

Ann Tran, MD

Assistant Professor
Icahn School of Medicine at Mount Sinai
New York City, New York, United States

Disclosure information not submitted.

Senior Author(s)

SH

Sue J. Hahn, MD

Assistant Professor of Surgery
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Josh Appel, MD, MSc, FRCSC: This individual has no financial relationships with ineligible companies.

Jordan Roy, MD: This individual has no financial relationships with ineligible companies.

Jared S. Matson, MD: This individual has no financial relationships with ineligible companies.

Jorge Zarate Rodriguez, MD: This individual has no financial relationships with ineligible companies.

Katherine W. Lam, MD: This individual has no financial relationships with ineligible companies.

Patricia Sylla, MD, FACS, FASCRS: Activ Surgical: Consultant (Ongoing); Ethicon: Consultant (Ongoing); Medtronic: Consultant (Ongoing); Moon Surgical: Consultant (Ongoing); Safeheal: Consultant (Ongoing); Stryker: Consultant (Ongoing)

Purpose/Background: Robotic ventral mesh rectopexy is becoming increasingly more prevalent as a minimally invasive technique used to treat rectal prolapse. Although it is an excellent option for treating rectal prolapse, recurrences do occur. These can be solely attributed to technical failures such as mesh detachment from the sacral promontory, however are more commonly related to patient factors and are multifactorial in nature. The reason for recurrence may dictate how best to reattempt a surgical repair. In some cases, patients may not always benefit from or need a repeat low pelvic dissection in order to repair recurrent rectal prolapse.

Methods/Interventions: This is a 25-year-old female with a past medical history of anorexia and myotonic dystrophy type IA who had two years of rectal prolapse requiring manual reduction and occasional incontinence of stool and gas for which she wore a diaper. She had an initial BMI of 16.8, which improved to 18 with nutritional optimization. She was initially taken for an uncomplicated robotic ventral mesh rectopexy. Unfortunately, six months later, following ~4 months of bloody diarrhea secondary to prolonged COVID-19 and Norovirus, she presented with recurrent rectal prolapse. She worked with the gastroenterology team to manage her symptoms and her work up included a colonoscopy and MR defecography which revealed tricompartmental prolapse. A multidisciplinary approach was taken and the urogynecology team was involved. Following a detailed conversation with the patient and the team, she was taken to the OR for repeat robotic ventral mesh rectopexy as well as sacrohysteropexy with urogynecology. In this video, we demonstrate the identification of an incorporated mesh which had detached from sacral promontory. After simultaneously retracting the mesh cephalad towards to the sacral promontory on tension, and performing a digital rectal exam, we could appreciate that the mesh remained adherent to the anterior rectal wall and was successfully reducing the prolapse. Considerations included that this was a young female patient who wished to maintain future childbearing options, and it would be beneficial to avoid a repeat low pelvic dissection. As such, the decision was made to suture the incorporated mesh to the sacral promontory after mobilizing and trimming this tissue. Our gynecology colleagues then performed a sacrohysteropexy and secured their mesh to a more proximal location on the sacral promontory. Following this, the peritoneum was re-approximated over both pieces of mesh.

Results/Outcomes: This video highlights contributing risk factors and considerations when dealing with recurrence of rectal prolapse following a robotic ventral mesh rectopexy in a young female. The patient had an unremarkable post operative stay and was discharged home in stable condition. She is recovering well without any evidence of recurrence, now two months from her operation. She continues to engage in pelvic floor physiotherapy and biofeedback.

Conclusion/Discussion: Robotic ventral mesh rectopexy remains a prominent method for treating rectal prolapse. Rates of recurrence are low, however they increase with patient risk factors such as poor nutritional status and connective tissue disorders. Technical failure rates in expert hands remain low, but not zero. With young female patients, fertility should always be discussed, and when possible it is beneficial to avoid repeat low pelvic dissections. When counselling patients, the above considerations should be discussed in order to make an informed, patient-centric decision.