The best surgical repair for rectal prolapse remains controversial. There are two vastly different surgical approaches: perineal and abdominal. Although the abdominal approach has a lower recurrence rate, perineal procedures spare the patient the pain and complications of abdominal surgery. While the surgery performed should be tailored to the individual patient, the question remains as to which approach is superior. This article objectively reviews the literature and demonstrates why the perineal proctosigmoidectomy is the better operation for repairing rectal prolapse.