It has been historically difficult to compare recurrence rates after different operations for rectal prolapse, given the multiplicity of available options, heterogeneous disease presentation and patient population. While the anticipated recruitment number had to be reduced due to slow accrual this trial remains the largest one attempting such an ambitious endeavor. The authors were unable to determine the superiority of any particular procedure over another. However, it was reassuring to note that surgery for rectal prolapse in general was associated with a substantial improvement in quality of life.