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

Figure 2 Surgical technique of prolapse and hemorrhoids-stapled transanal rectal resection procedure. A, B: A CAD was introduced into the anal canal, and a sterile betadine gauze hold with a pincer should be used to draw the prolapsed tissue inside the dilator; C: Three purse-string sutures in all of the layers of the rectum were made at 1 cm intervals using Prolene 2-0 in the anterior area of the rectum at 4 cm above the dentate line and from the 9 o’clock direction to the 3 o’clock direction including the apex of the anterior rectocele; D: A PPH device was inserted into the anal canal and closed and fired to perform the rectal anastomosis, and the staple line was reinforced using a 3-0 absorbable Vicryl suture; E: The same procedure was repeated on the posterior rectal wall; F: The resected sample. PPH: Procedure for prolapse and hemorrhoids; STARR: Stapled transanal rectal resection; CAD: Circular anal dilator.