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Patients with evacuation difficulties attributed to a rectocoele often have a combination of functional and anatomical abnormalities. We aimed to assess the effect of STARR on these abnormalities together with the symptoms thatpredicted good outcome.Seventeen women (age range 37-79, parity 1-5) with a symptomatic rectocoele underwent the STARRprocedure. They had the followingpre- and post-procedure: dynamic anatomical assessment (Barium and MRproctography), functional assessment (Wexner questionnaires and anorectal physiology). Mean duration of follow up was 17 months.Mean Wexner scores fell from 15 to10. Mean surface area resected was 25.8 (15- 40.25) cm2. The change in Wexner scores correlated with change in surface area (P = 0.005). Baproctography revealed new peritoneoceles in three of six patients assessed. On MRproctography 25- 38% developed anterior or central compartmentprolapse. Two patients required a re-doprocedure using a transvaginal approach, two required SNS for faecal incontinence. Those without anismus had fewer recurrences of symptoms.Whilst the STARRprocedure improved bowel evacuation in some patients, itpredisposed towards new and worseningprolapse of pelvic viscera and new onset of incontinence in 12%. STARR should be cautiously considered in those with anismus, faecal incontinence and pelvic organprolapse.