Rectal prolapse surgery has two different approaches: Abdominal surgery (lower recurrence rate and better functional outcomes) or perineal surgery (in elderly patients, significant comorbidities, high risk patients for general anesthesia, previous pelvic surgery or radiation).

Surgical management is indicated when conservative managements have failed.^[1][2]

Afford a lower recurrence rate with potentially better functional outcomes and below methods may be used:^[3]

• Ventral mesh rectopexy
• Posterior suture rectopexy (with or without sigmoid resection)
• Posterior mesh rectopexy

Elderly patients, patients with significant comorbidities, patients who are high risk for general anesthesia, previous extensive pelvic surgery or radiation^[4][5]

• Thiersch procedure: using a prothesis that narrows the anus
• Delorme procedure: peels off the herniated mucosa, plicates the exposed muscular layer, and sutures the anorectal mucosa
• Altemeier procedure (perineal sigmoid colorectal resection): the protruded rectum is resected 2cm above the dentate line and the mesentery of the sigmoid colon is pulled and ligated
• Gant_Miwa procedure: herniated mucosa is plicated by ligation, muscle layer is sutured and the anal opening is narrowed by a prothesis (not widely accepted)

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