©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Surg. Feb 27, 2026; 18(2): 116100
Published online Feb 27, 2026. doi: 10.4240/wjgs.v18.i2.116100
Published online Feb 27, 2026. doi: 10.4240/wjgs.v18.i2.116100
Beyond stapled transanal rectal resection vs ventral rectopexy dichotomy: Toward a phenotype-guided surgical paradigm for obstructed defecation syndrome
Michele Schiano di Visconte, Colorectal and Pelvic Floor Diseases Center, Department of General Surgery, Azienda ULSS2 “Marca Trevigiana”, Treviso 31100, Veneto, Italy
Sonia Sarnari, Colorectal and Pelvic Floor Diseases Center, Azienda ULSS2 “Marca Trevi
Co-first authors: Michele Schiano di Visconte and Sonia Sarnari.
Author contributions: Schiano di Visconte M and Sarnari S contributed equally to the conception and design of the study, interpretation of data, and drafting or critical revision of the manuscript for important intellectual content; both authors approved the final version for publication and agreed to be accountable for all aspects of this study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Michele Schiano di Visconte, MD, Chief, Colorectal and Pelvic Floor Diseases Center, Department of General Surgery, Azienda ULSS2 “Marca Trevigiana”, Via Sant’Ambrogio in Fiera 37, Treviso 31100, Veneto, Italy. mschianodivisconte@gmail.com
Received: November 2, 2025
Revised: November 18, 2025
Accepted: December 11, 2025
Published online: February 27, 2026
Processing time: 116 Days and 7 Hours
Revised: November 18, 2025
Accepted: December 11, 2025
Published online: February 27, 2026
Processing time: 116 Days and 7 Hours
Core Tip
Core Tip: The management of obstructed defecation syndrome must evolve beyond the suboptimal dichotomy of stapled transanal rectal resection vs ventral rectopexy. This review advocates for a fundamental paradigm shift toward a phenotype-guided stratified treatment algorithm. Mandatory preoperative phenotyping, integrating advanced imaging and high-resolution anorectal manometry, is crucial for classifying patients into distinct structural and functional subtypes. This personalized approach optimizes patient selection and yields superior, durable functional outcomes, thereby establishing a new framework for precision pelvic floor surgery.