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Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence\u2010Based Medicine (2009) level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010seven studies were identified, providing data on outcomes in 8340 patients. Average length of procedures was 44\u00a0min and length of stay (<jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content>) was 3\u00a0days. There was inadequate evidence to determine variations in procedural duration or <jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content> by type of procedure. Overall morbidity rate was 16.9% (0\u201361%), with lower rates observed after Contour Transtar procedure (8.9%). No mortality was reported after any procedures in a total of 5896 patients. Although inconsistently reported, good or satisfactory outcome occurred in 73\u201380% of patients; a reduction of 53\u201391% in Longo scoring system for obstructive defecation syndrome (<jats:styled-content style=\"fixed-case\">ODS<\/jats:styled-content>) occurred in about 68\u201376% of patients. The most common long\u2010term adverse outcome is faecal urgency, typically occurring in up to 10% of patients. Recurrent prolapse occurred in 4.3% of patients. Patients with at least 3 <jats:styled-content style=\"fixed-case\">ODS<\/jats:styled-content> symptoms together with a rectocoele with or without an intussusception, who have failed conservative management, may benefit from a rectal excisional procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Rectal excisional procedures are safe with little major morbidity. It is not possible to advise which excisional technique is superior from the point of view of efficacy, peri\u2010operative variables, or harms. 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