Stapled hemorrhoidopexy is a safe and effective treatment for Grade III and Grade IV hemorrhoids. Recurrence requiring reoperation was higher in Grade IV hemorrhoids than in Grade III hemorrhoids.

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Symptomatic pelvic organ prolapse (POP) can have an important impact on general health-related quality of life (QoL) and interfere, as a disability, with physical mobility, pain, emotional reaction, social isolation, energy and sleep (1). The impact of pelvic floor disorders on health related QoL is similar to the impact of other chronic and debilitating conditions as stroke, cancer, diabetes and dementia (2). Lifetime risk of undergoing at least one surgical procedure for prolapse and urinary incontinence (UI) is 11-18 % by the age of 79 years old and the reoperation rate for recurrence of these disorders is 29,2% (3). Over the next 30 years, demand for services to care for female pelvic organ diseases will increase at twice the rate of growth of the same population and the number of surgeries for UI and POP will increase substantially over the next 40 years (4). The high prevalence of POP results in high socio-economic costs and a significant impact on quality of life of these patients.Literature review in terms of colorectal pathology brings out some important observations: there is an unacceptable percentage of obstructed defecation syndrome (ODS) not resolved with conventional surgical procedures. The impact of surgical correction of prolapse symptoms on ODS remains unclear. There are few studies that explore this issue and the data that exist are mixed. Several studies suggest an improvement in constipation levels (5), while others demonstrated a worsening in symptoms or a significant degree of new-onset constipation (6). Furthermore, pre-operative clinical and instrumental evaluations rarely include anatomical-functional examinations of the rectum, thus neglecting that the rectum is one of the pelvic organs that has a high impact in pelvic dynamic, being daily more subjected to mechanical strains. If ODS persists or is created de novo in patients undergoing surgery for POP, this often results in intense straining which represents a daily mechanical stress on all the pelvic organs and supporting structures. We do not exclude that this could be a major cause of the high rate of relapse after conventional surgery. For these reasons, we believe that correcting ODS is a prerequisite in order to avoid relapses and im-

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