2026 Volume 10 Issue 3 Pages 474-479
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.
