Overview
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, Mr Nguyen carefully frees the front of the rectum and secures it back into its correct position using 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 enormously for your quality of life after surgery. The whole operation is done through small keyhole incisions under general anaesthesia.
Who needs this procedure?
- 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, Mr Nguyen can operate alongside a gynaecologist to repair everything in the same procedure
- Obstructed defaecation that hasn't improved with physio, diet, or other conservative measures — when straining and incomplete emptying is significantly affecting your daily life
Benefits
- Very high success rate — more than 9 in 10 patients with external rectal prolapse do not have it come back
- Done through 3–5 small keyhole openings — no large incision, less pain, and faster recovery
- The robotic approach allows nerve-sparing dissection that is superior to older-style posterior rectopexy, meaning less risk to bladder and sexual function
- 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
Risks & considerations
- Mesh-related complications — with the correct surgical technique, 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 Mr Nguyen will discuss it 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 far 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 significantly 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. With the robotic approach, this occurs in less than 3% of cases. Mr Nguyen will discuss your specific risk 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.
Before the procedure
Food: You may eat up until 6 hours before your admission time, then fast completely. Do not eat anything after this point — your procedure may be cancelled if you do.
Clear fluids: You may drink clear fluids up until 2 hours before your admission time. Clear fluids include: water (still or sparkling), cordial, sports drinks, lemonade, pulp-free apple juice, black tea or coffee, clear broth. Avoid red or purple coloured drinks.
Medications: Continue all regular medications as usual, taken with a small sip of water. Do not chew gum on the day of your procedure.
Supplements: Stop all non-prescribed vitamins, minerals, and herbal supplements (including fish oil, glucosamine, and vitamin E) at least 5 days before your procedure. Also stop iron supplements at least 7 days before.
Blood thinners: If you take warfarin, rivaroxaban (Xarelto), apixaban (Eliquis), dabigatran (Pradaxa) or clopidogrel, contact Mr Nguyen’s rooms for specific advice — these may need to be stopped or bridged before your procedure.
Diabetes medications: If you take oral or injectable diabetic medications (e.g. Metformin, Diamicron, Jardiance, Forxiga), stop these 2 days before your procedure. Do not stop insulin — contact our rooms for personalised dose adjustment instructions.
Weight loss injectables (GLP-1 agonists): If you take semaglutide (Ozempic, Wegovy), liraglutide (Saxenda), dulaglutide (Trulicity), or similar medications, remain on clear fluids for the full 24 hours prior to your admission time. You do not need to stop your medication. Please inform Mr Nguyen’s rooms when booking.
Mr Nguyen's preferred preparation is Picoprep (sodium picosulphate), taken as a split preparation — 3 sachets in total across the day before and morning of your procedure. Timing varies for morning versus afternoon procedures; the schedule below is for a morning procedure. If you have been advised to take a different preparation, refer to the Full Bowel Preparation Guide.
2–3 days before: Low-residue diet — white bread, white rice, plain pasta, eggs, skinless chicken or fish, plain yoghurt. Avoid wholegrains, most fruit and vegetables, nuts, seeds, and legumes.
Day before — until 3pm: White foods only (as above).
Day before — after 3pm: Clear fluids only. No solid food. Avoid red, purple, or green drinks.
Day before — 5pm: First sachet of Picoprep. Stay near a bathroom — bowel activity expected within 1–3 hours.
Day before — 8pm: Second sachet of Picoprep. Continue clear fluids.
Morning of procedure — 5am: Third (final) sachet of Picoprep, then 3–4 glasses of clear fluid. Take regular medications with a small sip of water. Motions should be clear to pale yellow by the end. Stop all fluids 2 hours before your scheduled arrival time — nil by mouth from that point.
- 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
On the day
- You will be completely asleep under general anaesthesia. You will be gently tilted head-down (Trendelenburg position) — this lets gravity move the bowel loops away from the pelvis, giving Mr Nguyen a clear view to work in
- Small keyhole openings are made for the robotic ports; the Da Vinci system is docked and connected
- Mr Nguyen carefully frees the front of the rectum 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
Recovery & aftercare
- 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 get the best possible result from your operation.
- Bowel function improvements — particularly with incontinence and difficulty emptying — typically develop over 3–6 months as the anatomy settles and the muscles recover.
- Mr Nguyen will see you for a follow-up review 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.
Related patient guides
Helpful articles written for patients and their families on topics related to this procedure.
Ready to discuss this procedure? Mr Nguyen consults at Heidelberg and operates at Austin Health, Warringal Private Hospital and Epworth Eastern. Call (03) 9816 3951, email admin@northeasternsurgical.com.au, or submit an enquiry online →