Objective The aim of this study was to evaluate the long-term results of perineal rectosigmoidectomy. Background Multiple surgical options are available for rectal prolapse perineal rectosigmoidectomy (Altemeier procedure) is the procedure of choice in elderly patients and those with multiple comorbidities. Methods Retrospective review was performed of all patients undergoing perineal rectosigmoidectomy from 1998 to 2008. Results Of 128 patients, 125 (98%) were women; with mean age 74 years. Mean operating time was 76 minutes. Hemostasis was achieved using ultrasonic scalpel or clamp and tie technique in equal numbers. Ultrasonic scalpel use resulted in shorter operative times (57.9 versus 94.7 minutes, respectively, P < 0.0001,) and estimated blood loss (18.8 versus 73 mL, respectively, P < 0.0001) compared to clamp-tie technique. Recurrence was seen in 23 (18%) patients. Recurrence was more after a handsewn anastomosis compared to a stapled anastomosis. Complications occurred in 3 patients (2%: 1 experienced major bleeding, 1 experienced perineal abscess, and 1 experienced postoperative ileus). Conclusions Perineal rectosigmoidectomy is associated with low morbidity and mortality. In addition, the minimal discomfort to patient, short length of stay and improvement in quality of life makes this a suitable operation for the elderly.