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To assess the efficacy and postoperative morbidity of STARR with a slight modification.Between 2004 and 2009, 48 female patients underwent the modified STARRprocedure. Theprocedure was selectively performed in patients with ODS based on the specific clinical, manometric and defaecographic findings. The modification of the technique permits the use of a single PPH 01 stapler which reduced costs substantially. A complete clinical reassessment including anorectal manometry and defaecography was performed after 1 year.In our patients we observed intraoperative bleeding in 34, postoperative rectal bleeding in 2, pelvic and new onset anorectal pain in three, urgency in five and minor fecal incontinence in two. Forty-eight patients completed a 1 year clinical and instrumental follow-up after surgery with a significant improvement of postoperative scores of outlet obstruction.STARR is a widely used operative technique for the management of ODS. To achieve a consistent success rate correct indications must be followed. Our modification of the standard technique allows a cost reduction without an increase of peroperative complications.