Growing familiarity with surgical staplers over the past few years has spurred research, in some cases multicenter studies, based on the STARR procedure [
11‐
17]. However, a number of complications have been reported [
18]. Therefore, to optimize the technique, some authors have proposed modifying the stapler [
19,
20] or using a single stapler, as proposed by Regadas et al. [
21]. The present study evaluated 35 female patients with ODS caused by rectocele and internal rectal mucosal prolapse. The patients were diagnosed by clinical, gynecologic, proctologic and cinedefecographic examination and underwent the TRREMS procedure. Preoperative and postoperative constipation and defecation scores were assigned, and patient satisfaction with surgical results, pain level and sexual function was measured with the VAS. The average age of our study population (47.5 ± 10.83 years) was similar to that of populations in other recently published studies evaluating the use of staplers in surgical correction of rectocele [
11,
16]. Likewise, the patients’ obstetric history matched findings in the literature [
11,
16,
19]: one patient was nulliparous and the remainder had had more than four deliveries, half of which were vaginal. It has recently been shown that normal delivery is not associated with rectocele [
16,
26,
27]. As in many other case series [
11,
16,
20], nearly half our patients (48.5%) had undergone previous surgery, including six perineoplasties and seven hysterectomies (one vaginal). The role of chronic straining in the genesis of rectocele in patients constipated for over 10 years has been well documented [
19,
28]. In our study, 59.37% of the patients with this condition evacuated once or twice weekly, while 8.56% evacuated two or three times a month, with a significant reduction in the average constipation score [
22] from 15.23 to 4.46 postoperatively (
p = 0.001), as reported by other authors [
8,
12,
14,
20] using different stapling techniques. The average ODS score also decreased significantly from 10.63 to 2.91 (
p = 0.001), matching findings for other stapling techniques [
11‐
16,
20,
29]. After surgery, patients reported little or no use of digitation, laxatives, sensation of incomplete evacuation or excessive straining. The functional continence score fell from 2.77 to 1.71 (
p = 0.001), although the overall level of continence was relatively satisfactory, ranging from 0 to 7 before surgery to 0 to 4 after surgery, matching findings of a study by Gagliardi et al. [
17] in which correction of rectal mucosal prolapse appears to have improved the mechanism of continence, a finding reported by Hausammann et al. as well [
16]. The fact that the patients stopped using laxatives after surgery also contributed to this improvement. In this study, the sensation of fecal urgency, tenesmus and anal discomfort was considered pain, and it was moderate (5.2) on the first postoperative day and slight (1.2) on the eighth day [
8,
12,
26]. Three (8.5%) patients complained of prolonged fecal urgency and anal discomfort for 3 weeks. The level of satisfaction observed (79.9, 86.5, 87.6 and 88.0 at 1, 3, 6 and 12 months, respectively) suggests patient approval to be similar for the TRREMS procedure and the STARR procedure [
13,
29,
30]. The reduction in rectocele size from 19.23 mm (range 3–42 mm) to 6.68 mm (range 0–17 mm) at rest and from 34.89 mm (range 20–70 mm) to 10.94 mm (range 0–25 mm) during evacuation (both
P = 0.001) is similar to findings for techniques involving two staplers [
8,
11‐
17,
29] or Contour Transtar™ [
19,
20]. Only minor complications were observed. In three early cases (8.57%) of moderate stenosis, mucosectomy was perceived to have been performed slightly too far from the dentate line: when the procedure was performed closer to the dentate line, no more complications occurred. Finally, it should be pointed out that while the aim of the study was not to compare the TRREMS procedure to the STARR procedure, the latter was included in the discussion as it is currently considered the gold standard for the treatment of rectocele associated with rectal prolapse and because so far very little information is available in the literature regarding the TRREMS procedure. In conclusion, the TRREMS procedure, requiring only one circular stapler, was found to be a safe and efficient technique for the treatment of rectocele associated with rectal mucosal prolapse, as shown by the significant reduction in obstructed evacuation and constipation scores and reduced levels of postoperative discomfort and complications. However, a further study should be developed enrolling more patients with longer follow-up time.