This video presents a case of an 89 year old female with a history of rectal prolapse. She was taken to the operating room for a perineal proctectomy. The prolapse recurred 2 months later. Given her age and comorbidities, she was not considered to be a good candidate for abdominal procedures. Therefore, she was taken back to the operating room for a re-do perineal proctosigmoidectomy with fluorescence angiography. The procedure was performed in the prone position. Once all redundant bowel had been mobilized, fluorescence angiography was used to examine the vascularity of the colonic conduit. A handsewn coloanal anastomosis was then completed. Levatorplasty had been performed at the time of her first repair and was not redone during the second procedure. The patient had an uneventful and brief hospitalization. She was discharged on POD 1.