Background: The aim of this study is to compare Block technique and Stapled trans-anal rectal resection for treatment of symptomatic rectocele associated with Obstructed Defecation Syndrome (ODS).Patients and Methods: 32 patients (all female) entered the study. All patients underwent anorectal manometry, defecography, and colonoscopy. Sixteen patients were treated with Block technique (Group A); 16 patients were treated with STARR (Group B). The two groups were homogeneous for the presence of preoperative symptoms such as pain (p 0.923), bleeding (p 0.704), mucous discharge (p 0.273), urgency (p 0.219) and in all patients the main complain was ODS. Visual analogue scale (VAS) was used for pain evaluation, Student T-Test to analyze quantitative variables, Fisher’s Exact Test for qualitative variables.Results: Hospital stay was respectively 2.7±1.8 days for Group A and 4±4.1 for Group B (p 0.27). Postoperative pain was significantly less in STARR compared to Block, 3.6±3.1 vs 4.8±3.2 respectively during the first five post-operative days (p 0.02). Pain duration in days was not different in the two groups: 13.6±13.2 Group B vs 13.9±15.9 Group A (p 0.950). The number of patients who had an improvement of ODS three months after surgery was 14 (87.5%) in both groups. Each patient was asked to quantify the percentage of improvement of ODS: the mean result was 67.5% improvement for Block vs 82% for STARR (p 0.19). We observed two major complications in Group B: one patient had severe retroperitoneal sepsis who required faecal diversion, the other had rectal bleeding requiring blood transfusions and Enterococcal infection requiring 1 months of antibiotic therapy; in Group A one patient had bleeding requiring blood transfusions.Conclusions: In this preliminary report comparing Block vs STARR technique for the treatment of rectocele postoperative pain was significantly less after STARR; although postoperative pain duration was not different. Hospital stay was longer in STARR but not significantly if compared with Block group. The improvement of ODS was present in 87.5% of patients in both groups and was similar quantified by the same patients. We report in one case treated with STARR a very severe retroperitoneal sepsis which needed reoperation with fecal diversion. The STARR technique showed less postoperative pain in this study with a similar outcome with regard to ODS compared to Block, but had higher costs, longer hospital stay and showed the possibility of life threatening complication.