Introduction: Sacrohysteropexy with concurrent rectopexy can be performed in women of childbearing age, with multicompartment prolapse, who wish to preserve their uterus. There is limited data regarding the use of mesh for prolapse repair in this population, therefore a biologic graft is often used to decrease the risk of contamination with colorectal surgery and allow for future pregnancy. We present the surgical management of prolapse repair in a young woman who presented with uterine and rectosigmoid prolapse, causing rectal outlet obstruction. Methods: Our patient is a 21-year-old woman with over a decade of severe constipation and abdominal pain. Her past medical history includes anxiety, depression and sexual abuse. She previously underwent robotic rectopexy for intra-rectal intussusception and mucosal prolapse with immediate improvement in her symptoms; however, two months after rectopexy, she suffered from persistent abdominal pain and severe difficulty passing stool. Dynamic resonance imaging demonstrated descent of the bladder with significant uterine prolapse, causing impingement of rectum and rectocele, blocking the evacuation of stool. The patient was thus indicated for concurrent sacrohysteropexy and rectopexy. Results: She underwent a robotic procedure. Given the patient’s age, in an effort to preserve future child-bearing potential, we elected to perform the surgery with a biologic graft made of fascia lata. The sacrohysteropexy was performed by suturing the graft to the posterior cervix. Intraoperatively she was noted to have an intact enterocele repair and posterior rectopexy from her previous surgery; however, the rectosigmoid attachment appeared to have stretched, creating an angulation at the rectosigmoid. This was corrected by performing a rectopexy to the fascia lata graft. The patient was discharged home the day of surgery without incident. Conclusions: Biologic grafts can be used for multicompartment prolapse repair in women of child-bearing age. Fascia lata provides a safe alternative to mesh to allow for future pregnancy. Also, sacrohysteropexy with concurrent rectopexy can be performed with same day discharge. SOURCE OF Funding: None
