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

Figure 4 Surgical technique of tissue selecting therapy-stapled transanal rectal resection procedure. A: A CAD was gently introduced and fixed to the perianal skin after digital anal dilatation to assess the scope and degree of prolapse and rectocele; B, C: The parachute technique with six figure-eight sutures was used to pull out the rectocele and prolapsed tissues, and the depth of each suture should reach the rectal muscular layer; D: A 36-mm TST stapler was placed through the CAD, and all traction lines were pulled out through the mega windows; E: The stapler was closed and fired to perform the rectal anastomosis, and the staple line was reinforced using a 3-0 absorbable Vicryl suture; F: The resected sample. TST: Tissue selecting therapy; STARR: Stapled transanal rectal resection; CAD: Circular anal dilator.