Robotic Ventral Rectopexy and Sacrocolpopexy with Biologic Mesh in an 88-Year-Old Woman with Crohn’s Disease: A Case Report

Abstract Background: There is a paucity of data on the surgical management of multicompartment prolapse in elderly patients with a history of inflammatory bowel disease. Biologic grafts represent an interesting modality to augment these repairs by providing structural support, but mitigating the inherent risks associated with synthetic meshes in these high-risk populations. Case presentation: An 88-year-old white female presented with full thickness rectal prolapse. This was initially managed with robotic-assisted laparoscopic suture rectopexy; however, the patient subsequently developed an isolated anterior rectal wall prolapse secondary to a large enterocele on physical exam and imaging approximately a year later. She was also noted to have post-hysterectomy vaginal vault prolapse. Given her complex surgical history, comorbid conditions and history of Crohn’s Disease, she subsequently underwent a robotic-assisted sacrocolporectopexy with a biologic graft, as well as posterior colporrhaphy/perineorrhaphy. Follow up at 6 weeks revealed excellent symptom resolution and anatomic findings. Conclusion: Robotic sacrocolporectopexy with biologic graft insertion is a feasible way to treat multi-compartment pelvic organ and rectal prolapse in older, medically complex patients who are at increased risk of synthetic mesh complications.