What is the STARR Procedure?

STARR (Stapled Transanal Rectal Resection) is a minimally invasive surgical procedure for Obstructed Defecation Syndrome (ODS). Using two circular staplers inserted through the anus, excess rectal tissue (rectocoele and internal intussusception) causing the obstruction is removed and the rectal wall is reconstructed — all through the anus, with no external incision.

Indications for STARR

• ODS with confirmed rectocoele and/or internal rectal intussusception on defaecating proctogram or MRI defaecography
• Failed conservative management (biofeedback, laxatives, pelvic floor physiotherapy) for at least 6 months
• Absence of significant anismus (paradoxical sphincter contraction) — this must be treated with biofeedback first
• No significant faecal incontinence (as STARR can worsen incontinence)

Procedure Details

• Duration: 30–45 minutes under spinal or general anaesthesia
• Day-care procedure — discharge same day or next morning
• Bowel preparation the evening before
• Return to desk work: 3–5 days
• Full recovery: 2–3 weeks
• Success rate (significant symptom improvement): 70–80%