The article presents a comparative study of the results of surgical treatment with abdominal and perineal approaches in patients with rectal prolapse. In 83 patients of both sexes (52 women) aged 16-85 years (median in women 46.5 ± 1.1, in men 48.2 ± 1.7 years) with rectal prolapse, abdominal or perineal fixation surgeries with and without resection of the prolapsed part of the rectum and minimally invasive surgeries were performed. After the abdominal or perineal procedures, including minimally invasive procedures, stable and successful results were obtained in 80 patients (96.4%). Recurrences occurred only in 2 cases, and mortality in 1 case. Local complications developed in the form of wound infection (6), and feeling of a foreign body during mesh rectopexy (3); general complications included sepsis (1) and constipation (3). No major complications were requiring repeated surgery. In rectal prolapse surgery, abdominal procedures are ideal for young patients, and perineal procedures are ideal for elderly and senile patients with severe concomitant pathology. Suture rectopexy is characterized by adequate treatment, while mesh rectopexy is not superior to suture rectopexy. However, meshes as a foreign body increase the risk of local infection. Both rectopexy options are popular with many surgeons and the choice depends on the experience and preference of the surgeon. Laparoscopic rectopexy has results that are equivalent to or better than open pexy. It is preferred because it is simple and easy to perform. The results of perianal rectosigmoidectomy are much better than Delorme procedures, especially when the posterior levatoroplasty is added to it.