Background: Several operations have been proposed to correct rectal prolapse, which can be done either via 
transabdominal or perineal approach but the best operation for rectal prolapse still remains a controversial subject. 
Patients and methods: Twenty-four patients with complete rectal prolapse were randomly divided into two groups, group I, comprised 12 patients underwent abdominal posterior mesh rectopexy (APMR) and group II, comprised 12 patients underwent posterior sagittal mesh rectopexy (PSMR). Preoperative assessment of the patients included full history taking, thorough general examination, meticulous perineal examination with digital assessment of the sphincter tone, barium enema and colonoscopy. Patients with fecal incontinence were evaluated by anal manometry and endoanal ultrasonography.. 
Results: Mass protruding through the anus on straining was the commonest complaint in 100%, constipation in 75%, pruritus ani in 62.5% and incontinence to flatus in 25%, to loose stool in 12.5% and to solid stool in 8.3%. The average operative time was 103 minutes in group I (APMR) and 74 minutes in group II (PSMR). There were no technical problems during both procedures. All patients were followed up regularly for a period ranged between 12 - 30 months. Recurrence was reported in 2 patients (16.6 %) of group II (PSMR) and no recurrence in group I (APMR). Among the 9 male patients of both groups no postoperative sexual changes were reported. Four patients (33.3 %) of group I and 3 patients (25 %) of group II had postoperative temporary constipation. The patients presented with preoperative anal incontinence to flatus and to loose stool regained continence within 2 months postoperatively, while 2 patients (one in each group) presented with incontinence to solid stool (8.3%) required surgical correction. 
Conclusions: In patients who are able to tolerate a major operation without undue risk, the abdominal approach is 
preferred, because the recurrence rate is low, and the complications rate are acceptable. Posterior sagittal approach may be better for patients with fecal incontinence because of simultaneous post anal repair, however, it is associated with higher incidence of recurrence. Also because of the minimal dissection, short operative time, use of spinal anesthesia, and rapid recovery, this procedure can be used in patients with marked compromised general condition.