Annals of Coloproctology

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Guideline

Anorectal physiology & pelvic floor disorder

The Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of obstructed and ineffective defecation syndrome: Adolfo Renzi, Luigi Brusciano, Pasquale Talento, Luigi Marano, Francesca Iacobellis, Antonio Vallo, Giovanna Frezza, Maurizio Grillo, Alessio Palumbo, Elisa Palladino, Benedetto Neola, Fabrizio Foroni, Michele Lanza, Massimo Antropoli, Carmine Antropoli, Mauro Natale Maglio, Maria Laura Sandoval Sotelo, Gianluca Pagano, Maria Michela Di Nuzzo, Luciano Vicenzo, Michele Schiano di Visconte, Gabriele Naldini, Leonardo Lenisa, Marcello Gasparrini, Giuseppe Candilio, Massimo Pezzatini, Francesca Ascari, Alberto Di Leo, Monica Urbani, Simona Ascanelli, Alessandro Bussotti, Natale Calomino, Domenico Izzo, Roberto Peltrini, Michele D'Ambra, Giovanni Greco, Giuseppe D'Oriano, Alfredo Giordano, Claudio Gambardella, Diletta Paola Iovino, Andrea Grego, Luigi Pellecchia, Luigi Monaco, Ilaria Ferrante, Giovanni Luca Lamanna, Vinicio Mosca, Sergii Girnyi, Gianluca Minieri, Luigi Losacco, Giacomo Sarzo, Giuseppe Calabrò, Francesco Ghiglione, Sergio Agradi, Michele Pinto, Andrea Marazzi, Mariangela Desantis, Federico Maria Mongardini, Massimo Mongardini, Aurora Marotta, Andrea Lauretta, Giovanni Ferreri, Alfredo Annicchiarico, Francesca Da Pozzo, Alfredo Ansalone, Matteo Zuin, Nadine Osman, Paolino Mauro, Corrado Rispoli, Tomasz Cwalinski, Roberto Rizzato, Nando Gallese, Marta Mozzon, Alessandro Stazi, Luana Franceschilli, Angelo Stuto, Eugenio Cudazzo, Silvia Malerba, Riccardo Brachet Contul, Antonio Canero, Nicola Antonacci, Francesca Milazzo, Costantino Magnani, Cristina Folliero, Francesca Babic, Silvia Marola, Andrea Braini, Guido Benegiamo, Umberto Cocozza, Bruno Masci, Rita Laforgia, Angela Pezzolla, Antonio Colangelo, Carmelo Geremia, Raffaella Marina Di Renzo, Claudio Pagano, Roberto Picheo, Umberto Favetta, Fabrizio Gambarini, Laura Chimisso, Gianmattia Terracciano, Adelaide Andriani, Giovanni Marino, Patrizia Liguori, Carmen Formisano, Izabela Zofia Paszkiewicz, Alfonso Reginelli, Francesco Tumminelli, Martina Caruso, Marianna Pennacchio, Francesco Antonio Ciarleglio, Nicola Lizza, Francesco d’Aniello, Lorenzo Asciore, Pierluigi Bianchi, Emanuela Tessari, Eleonora Rossin, Maria Paola Menna, Giampiero Ucchino, Fabrizio Vittadello, Monica Oliva, Francesca Gatto, Raffaella Ferrando, Ilaria Granese, Mario Cicconi, Massimiliano Mistrangelo, Giovanna Ioia, Valeria Gianfreda, Ettore Greco, Adriana Maria Landolfi, Giandomenico Di Sarno, Vincenzo Landolfi, Carolina Bartolini, Luciano Onofrio, Domenico De Vito, Salvatore Napolitano, Vincenzo Bottino, Antonio Longo, Antonio Brescia, Chiara Casiraghi, Alfonso Alderisio, Mario Massimo Mensorio, Ludovico Docimo, Antonio Brillantino; Ann Coloproctol. 2026;42(2):151-178. Published online April 28, 2026; DOI: https://doi.org/10.3393/ac.2025.00899.0128

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Abstract PDF: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) on the diagnosis and management of obstructed defecation syndrome (ODS), with the purpose of guiding physicians in the selection of the most appropriate treatment option. A panel of experts was appointed by the Board of the SIUCP to develop key questions addressing the main topics related to the management of ODS and to perform an accurate literature search for each topic, in order to provide evidence-based answers and to summarize them in structured statements. All clinical questions were discussed by the expert panel over multiple rounds using the Delphi approach, and consensus among the experts was achieved for each statement. The questions were formulated according to PICO (patients, intervention, comparison, outcome) criteria, and the statements were developed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In patients with ODS refractory to first-line medical therapy, rehabilitation may be considered as a therapeutic option, particularly in cases of dyssynergic defecation, whereas a surgical approach may be indicated in patients with a high symptom score and an Oxford prolapse grade system score ≥3 on defecography (using magnetic resonance imaging or another modality). Surgical options include stapled transanal rectal resection and ventral mesh rectopexy, eventually combined, respectively, with pelvic organ prolapse suspension and sacrocolpopexy in the presence of multicompartment pelvic prolapse. A transverse perineal support procedure may be considered in the presence of excessive perineal descent. In patients with recurrent symptoms after surgery, transanal irrigation may represent a useful therapeutic option.

Original Article

Anorectal physiology & pelvic floor disorder

Laparoscopic ventral mesh rectopexy with and without transverse perineal support using biological mesh for rectal prolapse and perineal descent: postoperative course and functional outcomes: Maria Clelia Gervasi, Giorgio Brancato, Lorenzo Crepaz, Ahmad Tfaily, Alberto Di Leo; Ann Coloproctol. 2025;41(5):453-461. Published online October 28, 2025; DOI: https://doi.org/10.3393/ac.2025.00080.0011

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Abstract PDF Supplementary Material

Purpose
Laparoscopic ventral mesh rectopexy (LVMR) is effective for the treatment of rectal prolapse. However, descending perineal syndrome may impair the outcomes of LVMR. The aim of this study was to assess the safety and functional outcomes of LVMR performed with and without transverse perineal support (TPS).
Methods
This was a retrospective study of 143 consecutive female patients treated with LVMR with or without TPS between 2018 and 2022. Patients with rectal prolapse and perineal descent who underwent surgery were included. Obstructed defecation syndrome and fecal incontinence were evaluated using the Cleveland Constipation Score (Wexner score) and St. Mark’s Incontinence Score, respectively. Perineal descent was defined using defecography. Biological meshes were utilized in all cases.
Results
No significant differences were recorded between with- and without-TPS groups at baseline. TPS was performed in 110 patients (76.9%). Surgical morbidity was higher in the with-TPS group (12.7% vs. 0%, P=0.047), primarily due to seroma formation. Almost all complications were mild (Clavien-Dindo grades I–II). In both groups, digital aid for defecation (P<0.001), prolonged straining (P=0.004), and hematochezia (P<0.001) nearly disappeared postoperatively, though constipation and laxative/enema use persisted in 22.4%. Fecal incontinence significantly decreased from 43.4% to 11.2% (P<0.001). TPS appears to have a potentially favorable effect in reducing the constipation score. Both constipation and incontinence scores remained low up to 24 months after surgery. Operative time was significantly longer in the LVMR with-TPS group (P<0.001).
Conclusion
LVMR with TPS appears safe and feasible. TPS may provide better surgical outcomes compared to LVMR alone for patients with symptomatic rectoceles and descending perineum syndrome.

Citations

Citations to this article as recorded by

Beyond stapled transanal rectal resection vs ventral rectopexy dichotomy: Toward a phenotype-guided surgical paradigm for obstructed defecation syndrome
Michele Schiano di Visconte, Sonia Sarnari
World Journal of Gastrointestinal Surgery.2026;[Epub] CrossRef

Case Report

Colorectal cancer

Treatment of side limb full-thickness prolapse of the side-to-end coloanal anastomosis following intersphincteric resection: a case report and review of literature: Guglielmo Niccolò Piozzi, Krunal Khobragade, Seon Hui Shin, Jeong Min Choo, Seon Hahn Kim; Ann Coloproctol. 2024;40(Suppl 1):S38-S43. Published online February 8, 2023; DOI: https://doi.org/10.3393/ac.2022.00829.0118

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