Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience

Table 2 Overview and summary of cons of each transanal operative procedure

Procedure	Cons	Ref.
Partial division of puborectalis	Disappointing short-term follow-up outcome	[34,38,57]
	Increased risk of postoperative fecal incontinence	[34,38,57]
Internal Delorme’s procedure	Unsatisfactory long-term follow-up outcome with disadvantages such as high recurrence rate, long operative time and complications such as constipation, fissure-in-ano, and transient incontinence	[39,53,55,60,61]
	Unsuitable for patients with ODS and diarrhea	[53]
	Requiring additional sphincteroplasty for patients with ODS and severe fecal incontinence	[60]
	Without superiority to stapling procedures in treatment of rectocele induced ODS	[39,55]
PPH-STARR procedure	Disappointing long-term follow-up outcome with disadvantages such as a long learning curve and complications such as bleeding, puborectalis dyssynergia, urinary retention, granuloma of anastomotic stoma and recurrent ODS	[41,63,67-70,79,80]
	With some severe postoperative complications such as severe proctalgia, fecal incontinence and rectovaginal fistula	[75-78]
	With rare complications such as rectal diverticulum and sigmoid volvulus	[81,82]
	Unsuitable for patients with previous pelvic floor surgery or sphincter weakness	[66,68-70,76-80]
	Limitation of resection of a large volume of prolapsed tissue and difficulty in visualizing the procedure	[41]
Contour-Transtar procedure	Disappointing long-term follow-up outcome with disadvantages such as a long learning curve , relatively complicated procedure, high cost and complications such as bleeding, puborectalis dyssynergia, urinary retention, granuloma of anastomotic stoma and recurrent ODS	[65,87,89,90,97]
	With some severe complications such as recto-vaginal fistula, fecal urgency, fecal incontinence and anorectal pain	[87,89,90]
	Unsuitable for patients with previous pelvic floor surgery or sphincter weakness	[65,87,89,90,97]
	Without superiority over PPH-STARR procedure	[65,97]
Bresler procedure and liner stapler and bioabsobable stapler line reinforcement material	Limited effect on rectal intussusception and unsuitable for patients with sphincter weakness	[45,48,99,100]
TRREMS procedure	Limited effect on severe rectocele	[44]
	Unsuitable for patients with sphincter weakness	[42-44,101]
TST-STARR procedure	Unsuitable for patients with sphincter weakness	[11]

TRREMS: Transanal repair of rectocele and rectal mucosectomy with a single circular stapler; TST: Tissue selecting therapy; PPH: Procedure for prolapse and hemorrhoids; STARR: Stapled transanal rectal resection.