Objective To investigate the association between gender difference and postoperative recurrence risk of complete rectal prolapse (CRP), and to provide a scientific basis for gender-specific management of clinical prognosis.

Methods In this retrospective cohort study, 180 CRP patients who underwent surgical treatment at Guang'anmen Hospital, China Academy of Chinese Medical Sciences from January 1, 2013 to June 30, 2024 were enrolled. Two sequential survival analysis models were applied to examine the overall recurrence rate, cumulative recurrence-free survival rate, and independent associations between gender and postoperative recurrence.

Results Among 180 CRP patients, 91 (50.6%) were male and 89 (49.4%) female. The recurrence in male patients was 29.7%, lower compared to 44.9% in female counterparts. In the unadjusted model, female patients had a hazard ratio (HR) of 2.66. After adjusting for age and body mass index (BMI) (Model 1), the HR decreased to 2.44. Further adjustment for course of disease and length of prolapse (Model 2) yielded an HR of 2.37 (95% confidence interval (CI): 1.01-5.58, P = 0.048). All models demonstrated significant gender differences in recurrence risk, with consistent findings between cumulative recurrence-free survival analysis and multivariate analysis.

Conclusions Female patients exhibit a 2.66-fold higher recurrence risk than males in the unadjusted model. This difference remains statistically significant after adjusting for confounders such as age, BMI, course of disease, and length of prolapse, indicating that female gender is an independent risk factor for postoperative recurrence of CRP.