<p>External full-thickness rectal prolapse represents a&#xa0;rare yet clinically significant condition, associated with frequently pronounced functional disorders, the definitive treatment of which can only be surgical. Despite the multitude of available surgical techniques, with over 100 described procedures, the underlying evidence remains contradictory. The aim of this review is to summarize the current data concerning abdominal and perineal surgical procedures, analyze their functional outcomes and recurrence rates, and present the key influencing factors necessary for patient-oriented therapeutic decision-making. Recurrence rates observed for any given procedure are high. Abdominal procedures generally demonstrate lower recurrence rates without resulting in an increased perioperative morbidity profile compared to perineal interventions. Given the substantial heterogeneity and lack of high-quality comparative data, no universally standardized treatment algorithm can be reliably derived. Consequently, the therapeutic decision must be highly individualized, carefully weighing both the necessity of maximizing surgical expertise and incorporating patient preferences.</p>