Longitudinal plication for rectal prolapse: An 8-year retrospective cohort study

Full-thickness rectal prolapse (FTRP) impairs quality of life through incontinence, constipation, and social embarrassment. While abdominal approaches offer lower recurrence, perineal techniques are preferred for high-risk patients despite recurrence rates of 10–30%. This study evaluates complications of a novel perineal Longitudinal Plication (LP) technique designed to minimize invasiveness while maintaining efficacy. A retrospective cohort analysis (January 2014–December 2022) at Sulaimani Teaching Hospital included 108 FTRP patients undergoing LP. Standardized preoperative assessments excluded secondary causes. Under spinal (74.1%) or general anesthesia, LP involved spiral full-thickness plication at three circumferential points using absorbable sutures, with mucosal excision to prevent obstruction. Pediatric cases utilized two plications. Outcomes included complications, recurrence, operative duration, and hospital stay. Data were analyzed using descriptive and comparative statistics (SPSS v26.0). Among 108 patients (64.8% female; bimodal age distribution: 21.3% pediatric [1–10 years], 30.5% adults [≥41 years]), chronic constipation (35.2%) and idiopathic etiology (48.2%) predominated. The overall complication rate was 11.1%: perforation (0.9%), anal stenosis (1.9%), partial recurrence (1.9%), and full-thickness recurrence (6.5%). No major adverse events occurred. Mean operative time was 38.5±11.0 minutes; 72.2% were discharged within 6 hours. Longitudinal plication demonstrates safety and feasibility for FTRP across age groups, with low complication rates (11.1%), minimal recurrence (8.3% overall), and efficient recovery (day-case discharge in 72.2%). Its minimally invasive profile supports use in high-risk populations, though further prospective studies are warranted.