Background <p>External rectal prolapse is a&#xa0;rare condition that significantly impairs the quality of life. Surgery is the only curative treatment option.</p> Objective <p>Due to the variety of surgical procedures and the heterogeneous study landscape, uncertainty persists regarding the optimal surgical strategy. This study analyzes the available surgical techniques concerning their recurrence and complication rates and functional results.</p> Material and methods <p>Current studies, meta-analyses and randomized controlled trials on the surgical treatment of rectal prolapse were evaluated, considering both abdominal and perineal procedures.</p> Results <p>Abdominal procedures tend to show lower recurrence rates than perineal approaches, particularly in mesh-supported rectopexy. Although perineal procedures are more frequently used in older and multimorbid patients, no significant advantage is observed regarding perioperative morbidity. Overall, however, the study landscape is characterized by a&#xa0;high risk of bias.</p> Conclusion <p>The high methodological heterogeneity of the studies makes a&#xa0;definitive recommendation difficult. Therefore, it remains unclear which approach is superior in the long term.</p>