Clinical Outcomes and Recurrence Prevention in Laparoscopic Wells Rectopexy for Rectal Prolapse through Mesh Trimming and Fixation Techniques.

OBJECTIVES

Laparoscopic Wells rectopexy (LWR) is a standard procedure for rectal prolapse; however, recurrence and mesh-related complications remain clinical challenges, particularly in elderly patients with small pelvic anatomy. This study aimed to evaluate the clinical outcomes of a modified LWR technique featuring intraoperative mesh tailoring and a hybrid fixation method.

METHODS

We retrospectively analyzed 29 patients who underwent modified LWR between October 2014 and June 2025. Technical modifications included intraoperative trimming of the polypropylene mesh to fit each patient's pelvic dimensions and a hybrid fixation technique using both sacral tacks and continuous barbed sutures. Patient demographics, operative outcomes, and recurrence rates were evaluated.

RESULTS

The study cohort consisted of 29 patients (median age, 78 years; median body mass index, 20.3 kg/m2). All procedures were completed laparoscopically, with a median operative time of 171 min and minimal blood loss (median, 0 mL). The mesh was tailored to a median size of 12 × 8 cm, and fixation was performed using a median of eight tacks combined with barbed sutures. The median postoperative hospital stay was 4 days. One patient (3.4%) experienced a minor complication (Clavien-Dindo Grade II). During a median follow-up of 190 days, recurrence occurred in only one patient (3.4%) at 30 months postoperatively.

CONCLUSIONS

Our modified LWR technique, featuring individualized mesh tailoring and robust hybrid fixation, is safe and effective for high-risk, elderly Asian patients with small pelvic frames.