Rectopexy & Sacrocolpopexy (Pelvic Floor Repair) in Johannesburg

What it involves

Ventral mesh rectopexy lifts and secures a prolapsing rectum back to the sacrum using a soft mesh strip, restoring normal anatomy and function. Sacrocolpopexy lifts a prolapsing vaginal vault (top of the vagina, after hysterectomy or with apical prolapse) up to the sacrum with a mesh in the same anatomical plane. Both are done through small abdominal ports, robotically or laparoscopically.

Rectal prolapse is more common than most patients realise, particularly in older women and in patients with longstanding constipation or straining. Left untreated it worsens, and the associated faecal incontinence and mucus discharge severely affect quality of life. Ventral mesh rectopexy has a low recurrence rate and preserves bowel function better than older perineal repairs.

Vaginal vault prolapse — the top of the vagina descending after hysterectomy — and apical prolapse have a similar impact on quality of life. Sacrocolpopexy is regarded as the most durable repair for apical prolapse, and the abdominal (laparoscopic or robotic) route has largely replaced open sacrocolpopexy because recovery is much quicker.

Both operations use a small strip of soft polypropylene or biological mesh secured between the pelvic organ and the sacral promontory. Placement is precise: too tight and the patient has discomfort or evacuation difficulty; too loose and the prolapse returns. Robotic wristed instruments help make that placement reproducible.

For combined pelvic-floor cases, Dr Marais operates jointly with Dr Colin Martheze, urologist. A shared theatre list means both surgeons are docked at the da Vinci console together — the colorectal component (ventral mesh rectopexy) and the urological / vault component (sacrocolpopexy) are completed in a single anaesthetic, with one coordinated recovery.

Because these are benign pelvic-floor procedures, decision-making is heavily quality-of-life driven. Dr Marais will discuss non-surgical options (pelvic-floor physiotherapy, pessary support, bowel-habit management) and only recommend surgery when symptoms clearly justify it and non-surgical measures have been tried.

When it's indicated

Rectopexy is indicated for full-thickness external rectal prolapse, symptomatic internal (intussusception-type) prolapse, and selected cases of obstructed defecation syndrome. Sacrocolpopexy is indicated for symptomatic vaginal vault prolapse or apical prolapse — a bulging or dragging sensation, difficulty with bladder or bowel emptying, or discomfort with activity — where a durable, minimally invasive repair is preferred.

The approach

The robotic platform is particularly well suited to pelvic-floor surgery. The narrow bony pelvis leaves little room to work, and wristed instruments plus 3D high-definition vision allow precise dissection of the correct anatomical planes and accurate mesh placement onto the sacral promontory. Laparoscopic and robotic techniques give the same clinical result; the choice depends on the case and platform availability. When bladder, uterine or vaginal prolapse coexists with rectal prolapse, the operation is done jointly with Dr Colin Martheze (urologist).

Recovery

Typical hospital stay is one to two nights. Most patients walk within hours of surgery, eat and drink normally the same day, and are discharged the next morning. Return to desk work is usually within a week to ten days; heavy lifting and gym work are avoided for six weeks while the repair matures. Constipation is actively managed with laxatives in the early weeks to protect the repair.