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There is no consensus on the ideal operation for rectalprolapse and the debate continues. Resection rectopexy has low recurrence rates and is reputed to address constipation. Unfortunately, some patients do not have satisfactory bowel function despite restoration of continence.To elucidate the pathophysiology, weprospectively carried out isotope transit time before and at least two years after resection rectopexy in 40 patients median age 52 (range 24-73) with full thickness rectalprolapse.Preoperatively, 28 patients (70%) had delayed colonic transit study. Patients with delayed transit were older 54(31-73) vs 43(24-69) (P = 0.1). Twenty-two patients agreed to undergo postoperative colonic transit studies. Resection rectopexy failed to correct delayed colonic transit in all patients with abnormalpreoperative tests while four patients developed new delayed transit and three with normal transit were unchanged. No patient has developed recurrentprolapse on follow up at median 5 years (range1-9).This study suggests thatprolapse patients have a pan-colonic motility disorder that is not corrected by resection rectopexy. If resection rectopexy fails to correct abnormal transit this study questions the rationale for continuing to offer resection and could merit a randomised trial to compare a less invasive surgical option like ventral rectopexy.