Published online Sep 21, 2016. doi: 10.3748/wjg.v22.i35.7983
Peer-review started: March 25, 2016
First decision: May 12, 2016
Revised: June 23, 2016
Accepted: August 1, 2016
Article in press: August 1, 2016
Published online: September 21, 2016
Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors’ center is also presented.
Core tip: Transanal surgery for obstructed defecation syndrome (ODS) remains a challenge for colorectal surgeons. Possible reasons are that reported clinical outcomes of current transanal surgical procedures are controversial and the patient selection criteria for different procedures are usually deficiently described in the current literature. This article reviews the literature regarding transanal surgery, introduces current problems and options for treatment of ODS and summarizes essential assessments needed for patient evaluation and the benefits and problems of each procedure. The aim of this article is to improve the understanding of selective strategies of transanal operations and increase patient satisfaction.