PMC

(A) Resting state of leaflet plication clip (B) Leaflet plication clip mounted on deployment device – in closed/resting state, (C) Leaflet plication clip in open state, (D) Deployment device – leaflet plication clip mounts on its tip. (Asterisk = central loop of leaflet plication clip. Arrowhead = sharpened arms of leaflet plication clip. Arrow = tip of deployment device where clip is mounted. Ruler = 1mm marks)

Schematic representation of different types of plication, LP=longitudinal plication, TP=transverse plication, OP= oblique plication.

Longitudinal plication procedure for complete rectal prolapse management. (A) External view of the anal verge just after induction of the anesthesia before the longitudinal plication. (B) The prolapsed area is stretched out by traction and pulling apart through a pair of artery forceps at the mucocutanious junction. (C-F) Multiple pairs of artery forceps are used on two-opposite lines in parallel to the long axis of rectum. Step-by-step tractions with these artery forceps makes the prolaps completely exposed. (G) The first stitch of the longitudinal plication is inserted just proximal to the tip of the prolapse on the medial aspect at 3:00. (H) The longitudinal plication at 3:00 is continued, including 2–3 cm of whole thickness of rectal circumference. (I) Residual rectal-wall protrutions between the stitches are excised. (J) The longitudinal plication at 3:00 is completed, reaching the mucocutaneous junction. (K) The first stitch of the second longitudinal plication is inserted by taking a whole-thickness of the rectal wall medial and proximal to the tip of the prolapsed rectum at 7:00. (L) The longitudinal plication at 3:00 and 7:00 are completed. (M) The prolapsed part at 11:00 is dragged out. (N) The first stitch of the longitudinal plication at 11:00 is inserted, taking a whole-thickness of the rectal wall, at the medial and proximal to the tip of the prolapse. (O) The three longitudinal plication pillars at 3:00, 7:00, and 11:00 of the plolapsed rectal wall are completed.

Graphic illustration of internal and external intestinal plication surgery. A Internal intestinal plication (also named intestinal tube splinting, intestinal stenting or sutureless plication). B External intestinal plication (modification of Nobel-Childs procedure)