Enhancing Outcomes: Robotic-Assisted Ventral Mesh Rectopexy for Rectal Prolapse

Robotic-assisted ventral mesh rectopexy (VMR), available at The George Washington University Hospital, is a valuable tool to repair rectal prolapse, offering an alternative to traditional and laparoscopic surgery. Studies have demonstrated that VMR successfully resolves debilitating symptoms associated with rectal prolapse, including constipation and fecal incontinence.

“Robotic-assisted ventral mesh rectopexy is a safe and effective technique to treat rectal prolapse with low recurrence rate and good symptomatic relief and minimal morbidity,” says Bindu A. Umapathi, MD, MRCS, FACS, FASCRS, professor at The George Washington University Hospital School of Medicine and Health Sciences. “Patients can be discharged the same day or stay overnight in the hospital, and there is minimal disruption to day-to-day life.”

VMR may be used to treat patients with external or internal rectal prolapse and is performed under general anesthesia. The procedure is particularly beneficial to patients in which rectal prolapse is causing descent of full thickness of the rectal wall when the patient is pushing or straining. VMR may also be utilized to treat internal prolapse or internal intussusception, in which the rectum slides onto itself. As a result, a patient may experience obstructive defecation, making it difficult or impossible to initiate a bowel movement or achieve complete evacuation of the bowels. Additionally, VMR is a possible solution for treating large rectoceles.

The Anatomy of the Operation

To perform robotic-assisted VMR, a colorectal surgeon begins by making five small cuts in the patient’s abdomen. Each cut measures 8 millimeters in length. The surgeon then utilizes the robot to access and work inside the patient’s pelvis.

During robot-assisted VMR, the surgeon retracts the redundant portion of the rectum and performs dissection anterior to the rectum. The surgeon then secures sterile biological mesh to the perineum and the anterior wall before fixing the mesh to the sacral promontory.

“The mesh serves to obliterate the rectouterine pouch in the female or the rectovesical pouch in a male. This helps to reduce the space and treat rectal prolapse, intussusception and enterocele,” Dr. Umapathi says. “The robot helps with better visualization and fine dissection in the pelvis.”

Benefits and Risks

Patients who receive robotic-assisted VMR treatment from the trained colorectal surgeons at GW Hospital may experience a wealth of benefits, including:

• Improvement in fecal incontinence, reported by 92 percent of patients
• Improved obstructive defecation syndrome (ODS), reported by 84 percent of patients
• Reduction of prolapse and repositioning of the rectum to the original position

Additionally, the risk of recurrent rectal prolapse in patients who undergo robotic-assisted VMR is 2 percent to 3 percent, compared to an 8 percent to 10 percent risk for patients who undergo traditional prolapse procedures.

Risks associated with VMR are minimal and include:

• Infection if a natural mesh is used instead of synthetic mesh
• Migration of mesh

“Several research studies have established the superiority of robotic-assisted VMR over traditional prolapse procedures, and GW Hospital is a leader in cutting-edge surgical procedures,” Dr. Umapathi says. “We have excellent outcomes following colorectal surgery and are ranked better than our regional peers. Our comprehensive Enhanced Recovery After Surgery (ERAS) Protocol propels patients to an early and wholesome recovery.”