R. Pietroletti • M. Pescatori () Coloproctology Unit Villa Flaminia Hospital Via Bodio 58, I-00191 Rome, Italy E-mail: ucpclub@virgilio.it G. Dodi Coloproctology Unit University Hospital Padua, Italy G. Milito Coloproctology Unit Tor Vergata University Rome, Italy G. Binda Coloproctology Unit Galliera Hospital Genoa, Italy reported by seven patients, all presenting with anxiety. Four of them were multiparous. Three patients had fecal incontinence, both had vaginal deliveries. R-IMP recurred in six, obstructed defecation in seven cases. Four patients needed reintervention, one for suturing the bleeding area, one excising the recurrent prolapse, one for colpocele and one for rectal stricture. Four patients required biofeedback training for non-relaxing puborectalis and two needed psychotherapy. Conclusion Parity, spastic floor syndrome and psychoneurosis seem to be the risk factors predispos- ing to failure of DSP, which may be followed by severe complications and early recurrence of symptoms requiring reoperation. Key words Stapler • Rectocele • Mucosal prolapse • Constipation • Fecal incontinence • Anal pain Introduction Rectocele and internal rectal mucosal prolapse (R-IMP) may be associated with obstructed defecation and can be managed by several manual techniques, such as Block’s, Sarles’s and Khubchandani’s repairs that give a low com- plications rate and a success rate of 80%–95% [1–3]. Due to the familiarity of most surgeons with the stapling tech- nique, novel procedures have been recently reported, such as stapled transanal prolapsectomy [4], and stapled pro- lapsectomy with levatorplasty [5]. However, constipation recurred in 40% of cases following transanal prolapsecto- my at our Coloproctology Unit in Rome (unpublished data) and fatal complications have been reported after its association with levatorplasty [6]. Moreover none of these procedures are aimed at treating rectal intussuscep- tion, often associated with R-IMP. Therefore a novel operation, the STARR double stapling procedure (DSP), which consists of a transanal anteroposterior rectotomy, G. Dodi • R. Pietroletti • G. Milito • G. Binda • M. Pescatori Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation Received: 4 February 2003 / Accepted: 18 July 2003 ORIGINAL ARTICLE Abstract Background The STARR double stapling pro- cedure (DSP), i.e. transanal anteroposterior rectotomy, has been recently reported as a low-morbidity and effective operation for the treatment of rectocele and internal rectal mucosal prolapse (R-IMP) causing obstructed defecation. We report the postoperative complications and recurrence of symptoms following this novel operation. Patients and methods Fourteen chronically constipated women with R- IMP, aged 36–72 years, presented with either severe com- plications or recurrence of symptoms following DSP per- formed by means of two circular staplers. All were fol- lowed for a median period of 12 months (range, 2–24) after DPS. Results Severe rectal bleeding occurred in two cases postoperatively. Persistent severe anal pain was Tech Coloproctol (2003) 7:148–153 DOI 10.1007/s10151-003-0026-4 © Springer-Verlag 2003