Introduction: We compared outcomes of elderly patients (>70 years) who underwent the Altemeier procedure versus laparoscopic rectopexy for full‐thickness rectal prolapse. Materials and Methods: We reviewed our data from a prospective database and the medical records of patients treated at a single institution from 2002 to 2008. Patients who underwent surgery for full‐thickness rectal prolapse were evaluated. Results: Sixteen patients underwent laparoscopic rectopexy (median age 82 years; ASA 2.6), and 16 patients underwent the Altemeier procedure (median age 85 years; ASA 2.8). The Altemeier procedure patients had a significantly higher recurrence rate when compared to laparoscopic rectopexy patients (P<0.045). The mean length of follow‐up was longer for the Altemeier group (20 months) compared to the laparoscopic rectopexy group (28.5 months; most recurrence (5/6) occurred <1 year. The median length of specimen removed in the Altmeier group was 9.5 cm (6.5–18.5 cm). The majority of patients in both groups had preoperative fecal incontinence. Significantly more Altemeier patients reported worsening perioperative fecal incontinence at 1–3 months (p<0.046). All laparoscopic rectopexy patients underwent general anesthesia while 44% of the Altemeier patients underwent regional anesthesia (p<0.003). One laparoscopic rectopexy patient required reoperation for an incarcerated trocar site hernia. No other major complications occurred in either group. There was no difference in rates of minor complications. Discussion: Compared to the Altemeier procedure, laparoscopic rectopexy for elderly patients with rectal prolapse resulted in a significantly smaller recurrence rate, better perioperative fecal incontinence and an equivalent morbidity rate.