Robotic ventral mesh rectopexy

Robotic ventral mesh rectopexy (RVMR) is an operation to fix a prolapsed rectum — your rectum is the final section of your large bowel, and when it loses its normal support it can slide downwards (prolapse), either protruding outside the body or slipping inside where it doesn't belong.

Using the Da Vinci robotic system, the front of the rectum is carefully freed and secured back into its correct position with a small piece of surgical mesh attached to a firm bony point at the front of the sacrum (the sacral promontory). The robotic approach provides a magnified 3D view in the tight space of the pelvis and allows the fine nerves that control your bladder and bowel to be preserved — which matters substantially for your quality of life after surgery. The whole operation is done through small keyhole incisions under general anaesthesia.

RVMR is the modern abdominal approach to rectal prolapse. For frailer or older patients in whom a full abdominal operation is not appropriate, perineal approaches (Delorme's or Altemeier's procedure) — done entirely from below, without entering the abdomen — remain an option. See the Rectal Prolapse condition page for the broader picture of how the right operation is chosen.

• Full-thickness external rectal prolapse — the rectum protrudes completely through the anus, which is distressing and worsens over time without treatment
• Symptomatic internal rectal prolapse (intussusception) — the rectum telescopes inside itself rather than protruding outward, causing difficulty emptying the bowel (obstructed defaecation)
• Solitary rectal ulcer syndrome — a condition linked to internal prolapse where repeated straining causes a sore (ulcer) inside the rectum, causing bleeding and mucus discharge
• Prolapse that has come back after a previous repair — particularly after a perineal (bottom-end) repair, where a more definitive abdominal repair is now needed
• Combined rectal and uterovaginal prolapse — when the uterus or vaginal walls are also prolapsing, the procedure can be performed alongside a gynaecologist so everything is repaired in the same operation
• Obstructed defaecation that hasn't improved with physio, diet, or other conservative measures — when straining and incomplete emptying is significantly affecting your daily life

• Durable result for most patients — published series report that the majority of people with external rectal prolapse remain free of recurrence
• Done through 3–5 small keyhole openings — no large incision, less pain, and faster recovery
• The robotic approach uses a ventral (front-side) mesh fixation rather than older posterior approaches; this preserves the nerves that run along the sides of the rectum and reduces the risk of bowel and sexual-function disturbance that can follow more extensive posterior dissection
• Fixes the underlying anatomy — the rectum is returned to its correct position and held there securely with mesh
• Most patients go home within 2–4 days
• Many patients notice an improvement in their bowel symptoms within weeks, with fuller improvement over the following months

• Mesh-related complications — in published series, mesh erosion (the mesh rubbing through nearby tissue) or infection occurs in less than 2% of cases. This is a recognised risk with any mesh-based repair and will be discussed with you at your consultation.
• Prolapse coming back — about 5–10% of patients will have some recurrence of prolapse within 5 years. This is still better than leaving it untreated, and most recurrences are manageable.
• Constipation — in 10–15% of patients, constipation can worsen or appear for the first time after surgery. This usually responds well to dietary changes, laxatives, or pelvic floor physiotherapy.
• Pain during sex (dyspareunia) — because the mesh sits close to the vagina, there is a small risk of discomfort. This is reduced substantially by staying in the correct surgical plane during dissection, which the robotic approach makes easier.
• Nerve injury — affecting the nerves for bladder or sexual function. In published robotic series this occurs in less than 3% of cases. Your specific risk will be discussed at consultation.
• Port site hernia — a small hernia at one of the keyhole entry points. Occurs in less than 1% of cases and can be repaired if needed.

If you take blood thinners, diabetes medication, GLP-1 weight-loss injectables, or iron supplements, please flag this when you book — these need specific adjustments before the procedure. Full details are in the guides above.

• Anorectal manometry (a pressure test of the sphincter muscles) and a defaecating proctogram (an X-ray taken while you use the toilet, to see exactly what the rectum is doing) — these confirm the prolapse and help plan the surgery
• A cardiac and breathing assessment before surgery, because the operation is done with you tilted head-down (Trendelenburg position) and the anaesthetist needs to know your heart and lungs can handle this comfortably
• If your bowel function is significantly impaired before surgery — for example, severe incontinence — a stoma nurse may meet with you to discuss what support is available

• You will be admitted to Warringal Private Hospital on the morning of your surgery and put fully to sleep under general anaesthesia. You will be gently tilted head-down (Trendelenburg position) — this lets gravity move the bowel loops away from the pelvis, giving a clear view of the working area. (Robotic rectopexy is done at Warringal because that is where the Da Vinci platform is located.)
• Small keyhole openings are made for the robotic ports; the Da Vinci system is docked and connected
• The front of the rectum is carefully freed all the way down to the pelvic floor — the lowest point of the pelvis — using precise robotic dissection
• A soft surgical mesh is then fixed to the rectum and anchored to the sacral promontory (a firm bony point at the front of the sacrum) with permanent sutures — this holds the rectum securely in its correct position
• The ports are closed; you are repositioned flat and moved to recovery
• A urinary catheter (a tube to drain your bladder) will stay in overnight and be removed the following morning

• Day 1: You will be up and walking. Diet starts with liquids and progresses to normal food as you feel comfortable.
• Days 2–3: Most patients are ready to go home. You will be sore around the small port wounds but mobile and managing well.
• 4 weeks: You can return to office work. Please avoid lifting more than 5 kg — this protects the mesh fixation while it's settling in.
• 6–8 weeks: Full activity including exercise is fine for most patients.
• Pelvic floor physiotherapy is strongly recommended after surgery — a pelvic floor physio can help you retrain your muscles and support a good functional result.
• Bowel function improvements — particularly with incontinence and difficulty emptying — typically develop over 3–6 months as the anatomy settles and the muscles recover.
• A follow-up review is arranged 2–6 weeks after surgery — this appointment is provided at no charge.

Post-operative concerns: Please call our rooms on (03) 9816 3951 and leave a message — this will be sent directly as a text to Mr Nguyen. Alternatively, you may text the office mobile on 0499 090 126. We aim to respond promptly during business hours.

Emergencies: For any life-threatening emergency, call 000 immediately or go to your nearest emergency department. Do not wait for a call back from our rooms. For the Austin Hospital Emergency Department: (03) 9496 5000.