Concomitant pelvic floor disorders are increasingly prevalent in the aging population, with >55% of women experiencing >2 pelvic floor disorders by age 80.1  Combined corrective surgery for multi-compartment prolapse can optimize the anatomic position of pelvic organs and reduce the need and costs of a second surgery.2 Combined sacrocolpopexy (SCP) and ventral rectopexy (VRP) has been described as an effective approach for treating rectal and vaginal prolapse with improvements in quality of life and bowel function.3,4 However, approaches in mesh application vary in the literature. We report our outcomes for combined robotic-assisted SCP and VRP using a single synthetic mesh.

A retrospective review was conducted to identify patients who underwent combined robotic SCP and VRP in South Texas between January 2024 and August 2025. All patients were evaluated by both a colorectal surgeon and a urogynecologic reconstructive urologist. Primary outcomes were recurrence of anatomical prolapse or symptoms. Secondary outcomes were complications from the prolapse repair.

Twenty-five patients who underwent combined robotic-assisted SCP and VRP were identified. Twenty-four (96.0%) patients were Hispanic. All patients presented with high-grade (III-IV) pelvic organ prolapse (POP) or obstructed defecation syndrome (table 1). 

Median operative time was 262.7 minutes with concomitant hysterectomy and 221.8 minutes without hysterectomy. Post-operative prolapse recurrence rate was 8.0% (one stage 2 and one stage 3 posterior prolapse). The patient with stage 3 posterior prolapse underwent repeat ventral rectopexy. Post-operative complication rate was 20.0%: UTI managed with antibiotics (n=2), persistent constipation managed with stool softeners (1), self-limited mild rectal bleeding (1), myocardial infarction on post-operative day 2 requiring percutaneous coronary intervention (1). Mean length of follow-up was 4.1 months (range 1-13 months).

In our series, recurrent prolapse rate was 8.0% and only occurred in the posterior compartment. No infectious mesh complications were encountered. By performing concomitant surgery, patients can avoid the costs and risks of undergoing a second operation.

Combined robotic-assisted SCP and VRP using a single mesh is an effective treatment for multi-compartment prolapse and/or obstructed defecation syndrome.

1.	Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008;300(11):1311–6.
2.	Wallace SL, Enemchukwu EA, Mishra K, et al. Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery. Int Urogynecol J 2021;32(9):2401–11.
3.	Wallace S, Gurland B. Approaching Combined Rectal and Vaginal Prolapse. Clin Colon Rectal Surg 2022;34(5):302–10.