Surgical correction of large pulsion enterocele is a contentious subject and until a technique is founded upon proper anatomic facts, the arguments will continue. Pulsion enterocele follows changes in the pelvic cellular tissues and levator ani complex; both defects must be corrected. Synchronous abdominoperineal repair attends to both defects with accuracy, and in a healthy woman who wishes to regain normal vaginal function, it should be the procedure of choice. During the past 11 years, 66 patients, many of whom had been unsucessfully treated by other techniques, have been managed with this procedure. Accurate follow-up has been possible in 60 patients, and of these women, 56 have been cured.