PURPOSE: “Outlet obstruction” is a complex functional disorder compelling patients to exhausting uneffective attempts to void. This study was designed to compare the effectiveness and a safety of the endorectal proctopexy (internal Delorme) vs STARR procedure in two groups of patients. METHODS: A total of 66 patients with rectocele and associated mucosal prolapse or anorectal intussusception between January 2006 and June 2010 were randomly assigned to Group # 1 Endorectal proctopexy with levatorplasty (ERPP) and Group # 2 STARR. Patients were assessed one week, six and twelve months after the operation. Operative time, postoperative pain, day of discharge and late complications was recorded. The time of recovery of work was also assessed. The continence score was updated with a constipation questionnaire. Quality of life after the operation and the overall grade of satisfaction were assessed and compared with radiological findings. All patients were reassessed after one year. RESULTS: The results in the two groups of patients show no significant difference between ERPP and STARR: the improvement in symptoms is similar but significant and well definite in both groups with a low incidence of postoperative complications. STARR procedure is just faster to perform even if more expensive. Dyspareunia slightly improved mainly in ERPP group, due probably to scar distention. CONCLUSION: The results of our experience indicate a significant improvement of symptoms with both techniques. The overall incidence rate of postoperative complications is low and similar between the two groups. As economical consideration, ERPP is less expensive.