Purposes The aim of this study was to assess the early outcomes and advantages of a modifi ed Gant– Miwa approach for the treatment of rectal mucosal prolapse in children and determine how this modifi cation helps decrease recurrence when compared with modifi ed Thiersch’s stitch in a prospective and randomized setting. Background Recurrence of rectal mucosal prolapse after rectal mucosal prolapse repair through the anus represents a problem for the surgeon and the patient. Although there are many trials to prevent this recurrence, a defi nite solution has not been found yet. Patients and methods The study included 60 children with rectal mucosal prolapse (mean age 3.6 ± 1.2 years) who were divided into two groups: group A (N = 30), comprising patients who underwent the modifi ed Gant–Miwa operation, and group B (N = 30), comprising patients who underwent a modifi ed Thiersch’s prolene stitch. Results The modifi ed Gant–Miwa operation was a successful approach with which to decrease constipation [2.0 (6.6%) vs. 9.0 (30%) cases; P < 0.05] and recurrence [1.0 (3.3%) vs. 5 (16.6%); P = 0.0002] to a great extent, although it was followed by more anal soiling in the fi rst 2 weeks (11.3 ± 0.7 vs. 3.7 ± 0.2; P > 0.05). Conclusion The modified Gant–Miwa operation was a successful approach for decreasing early postoperative morbidity, especially constipation and recurrence, and thus incidences of surgical redo because of complications were also fewer, despite it being associated with more anal discharge especially in the fi rst 2 weeks.