Aim Reported recurrence rates after perineal rectosigmoidectomy (Altemeier's procedure) in patients with full‐thickness rectal prolapse vary from 0% to 60%. The object of this study was to analyse risk factors for recurrence after this procedure. Method From May 2004 to December 2012, 63 consecutive patients suffering from full‐thickness rectal prolapse undergoing perineal rectosigmoidectomy were included. Of these 46 were female and the median age of the whole group was 79 (30–90) years. The median follow‐up was 53 (3–99) months. Patient characteristics and operative parameters were compared between patients with and without recurrence. Results One patient died and another patient needed re‐operation. Eight full‐thickness recurrences occurred in eight patients after a median of 18 (6–48) months. Stapled compared with handsewn anastomosis (hazard ratio 7.96, 95% confidence interval 1.90–33.47; P = 0.001) and shorter specimen length (hazard ratio 4.06, 95% confidence interval 0.97–16.99; P = 0.03) increased the risk of recurrence in Cox regression analysis. Conclusion The operative technique including stapled anastomosis and length of the resected specimen seems to be associated with a high recurrence rate after perineal rectosigmoidectomy.