Diagramatic illustrations of longitudinal plication to explain the sequence of the procedure. (A) The patient in lithotomy position and the prolapsed rectum is reduced. (B) The first step in pulling the prolapse out by traction through a pair of artery forceps fixed at the mucocutaneous junction of the anal canal. (C-F) Multiple pairs of artery forceps are used to pull the prolapsed rectum out successively. (G) Continous suturing of the first longitudinal plication (first pillar) is started at the most proximal part of the prolapsed rectum involving the entire rectal wall up to the mucocutaneous junction. (H) The longitudinal plication at 3:00 is completed and residual rectal-wall protrutions between the stitches are excised. (I) The longitudinal plication at 3:00 is completed, creating a pillar and contious suturing for the second pillar at 7:00 is started. (J) The second longtitudinal plication at 7:00 (second pillar) is completed. (K) sagital section shows the LP on 3:00 is completed and the anterior redundant rectal wall is still in. (L) sagital section shows the LP on 3:00 is completed with inserting the first stitch of the L.P. at 11:00, after its traction out through a sets of artery forceps. (M) the LPs on 3:00 and 11:00 are completed . (N) A cross-section shows a completed pillars at 3.00, 7.00 and 11.00, leaving the normal mucosa between pillars untouched. (O) An external view of the anal verge at the end of the procedure at the lithotomy position.