STARR (Stapled Transanal Rectal Resection) for Obstructive Defecation Syndrome (ODS)- Scarless

STARR is a surgical procedure which is used to treat Obstructive Defecation Syndrome (ODS), a condition which affects the rectum.

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Obstructed rectal passage in Obstructed defecation syndrome

The last part of the large intestine is called rectum. This is where the stool is stored before evacuation.

Childbirth, womb removal and old age may cause the rectal wall to slide out of its original place and hang into the canal through which the stool passes. The stool cannot move freely through this passage, resulting in difficulty passing motion. This condition is called Obstructive Defecation Syndrome.

Understanding STARR

Since this type of constipation is a result of physical obstruction, it is not relieved with help of medications like laxatives.

STARR is a procedure done to relieve the trembling constipation and take away the part of the rectum that blocks the path of the stools.

How is STARR Procedure Performed?

STARR (Stapled Trans-anal Rectal Resection) Procedure is performed by accessing the rectum through the anus (Transanal) with the help of proctoscope or anoscope.

Surgical stapler is a device which helps in trapping the prolapsed mucosa and chop it off. It also is kept in place to arrest the bleeding after the excision. This frees the lumen of any obstruction allowing free passage of stools. Hence the overgrowing mass is removed using a stapler.

STARR procedure to Chop off the prolapsed rectal mucosa

treatment window

STARR is performed because it is very embarrassing for a person to insert a finger and release the stool that is obstructed. It is better to perform a surgery and live a confident and comfortable life.


  • To have high fibre food.
  • Avoid spicy food.
  • Drink plenty of fluids.
  • Check for persisting bleeding while passing stools.

Video: STARR Procedure

STARR Procedure FAQ’S

This is a not so rare cause of severe constipation with the faecal load coming right down to the anal opening and stopping there.
It stops because it is prevented from exiting out of the anus, by a rectal wall infolding into the lumen of the gut and thus blocking the passage.
Patient will classically say that she/he is not able pass motion because it is blocked at the anal outlet. It will only exit when the patient inserts finger to release the bolus of motion. This is a very typical history obtainable from anal defecation syndrome patients.
Sometimes they also give history of undergoing pelvic surgeries like hysterectomy or other pelvic surgeries which presumably affect the nerves going to the anal sphincters in the outlet.
One test that definitely seems to help is the MRI defaecogram. In this, the patient is moved to empty the rectum that is loaded with contrast onto the console of the table of the MRI machine. During this period, the downward movement of the pelvic floor is tracked . A significant descent more than 2.5cms is strongly suspicious of ODS.
This is treated by a simple procedure called STARR. In this operation two sets of circular staplers are deployed to remove the projection ledge of rectal wall that acts as a valve and prevents the motion from exiting. It is a delicate procedure and is performed with staplers and is almost painless. The patient can go home the next morning; we are happy that at LIMA we did the first STARR procedure in Chennai at 2014. Since then, we have done a pretty large number of procedures with gratifying results.

STARR Specialists

Dr. J. S. Rajkumar


M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)

Dr. Anirudh Rajkumar

Bariatric and Laparoscopic Surgeon