12 year-old otherwise healthy male presented with a 4-year history of 3 cm full-thickness rectal prolapse, which reduced spontaneously after bowel movements and was associated with diarrhea and postprandial upper abdominal pain. Extensive workup demonstrated no functional or anatomic abnormalities to account for the prolapse. In the operating room, the patient was placed in lithotomy and the abdomen was entered through a 5-mm umbilical incision. Two additional 5-mm ports were placed in the right lower quadrant and right mid abdomen. With the patient in deep Trendelenburg, the rectum was readily delivered from the pelvis. The LigaSure device defined a plane in the presacral space on either side of the rectum while avoiding the ureters and hypogastric vessels, which were clearly visualized on laparoscopy. The dissection was extended posterior to the rectum to the level of the pelvic floor. A 3-mm stab incision was made in the left mid abdomen and a 3-mm bowel grasper was used to retract the rectum cephalad. This allowed for tension to be maintained during placement of two 2-0 Tycron stitches from the right aspect of the sacral promontory to the peritoneum of the rectum approximately 3 cm from the pelvic floor. Final examination confirmed balanced tension on the rectum with no further prolapse extracorporeally. The patient was transferred to the pediatric floor post-operatively and tolerated a diet on postoperative day 0. Bowel function returned on postoperative day 1 and the patient was discharged home on an oral bowel regimen.