Annals of Coloproctology

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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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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.

Citations

Citations to this article as recorded by

Tailoring surgery for obstructed defecation and its evolution into ineffective defecation: a new staging of the syndrome and a site-specific decision algorithm
Adolfo Renzi
Annals of Coloproctology.2026; 42(3): 372. CrossRef
Physiological Optimization of Digital Self-Disimpaction Using a Step Stool: A Case Report
Munehiro Yoshitomi
Cureus.2026;[Epub] CrossRef

Erratums

Corrigendum: Correction of the First Author's Affiliation. Outcome of Colorectal Surgery in Elderly Populations: Mostafa Shalaby, Nicola Di Lorenzo, Luana Franceschilli, Federico Perrone, Giulio P. Angelucci, Silvia Quaresima, Achille L. Gaspari, Pierpaolo Sileri; Ann Coloproctol. 2017;33(6):254-254. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.254

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Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study
Tamer A. A. M. Habeeb, Massimo Chiaretti, Igor A. Kryvoruchko, Antonio Pesce, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A. M. Adam, Mohamed A. Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H. Alsayed, Esmail Tharwat Kamel Awad, M
International Journal of Colorectal Disease.2025;[Epub] CrossRef

Erratum: Author Name Correction: Outcome of Colorectal Surgery in Elderly Populations: Mostafa Shalaby, Nicola Di Lorenzo, Luana Franceschilli, Federico Perrone, Giulio P. Angelucci, Silvia Quaresima, Achille L. Gaspari, Pierpaolo Sileri; Ann Coloproctol. 2016;32(5):199-199. Published online October 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.5.199

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Analysis of short-term functional outcomes of colorectal resections in older adults aged 75 years and older: a prospective single health board cohort study
V May, C MacKay, G Ramsay
The Annals of The Royal College of Surgeons of England.2026; 108(1): 33. CrossRef

Original Article

Outcome of Colorectal Surgery in Elderly Populations: Mostafa Shalaby, Nicola Di Lorenzo, Luana Franceschilli, Federico Perrone, Giulio P. Angelucci, Silvia Quareisma, Achille L. Gaspari, Pierpaolo Sileri; Ann Coloproctol. 2016;32(4):139-143. Published online August 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.4.139

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Abstract PDF

Purpose

The aim of this study is to investigate the impact of age on short-term outcomes after colorectal surgery in terms of the 30-day postoperative morbidity and mortality rates.

Methods

The subjects for the study were patients who had undergone colorectal surgery. Patients were divided into 2 groups according to age; groups A and B patients were ≥80 and <80 years old of age, respectively. Both groups were manually matched for body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index and procedure performed.

Results

A total of 200 patients, 91 men (45.5%) and 109 women (54.5%), were included in this retrospective study. These patients were equally divided into 2 groups. The mean ages were 85 years in group A (range, 80 to 104 years) and 55.3 years in group B (range, 13 to 79 years). The overall 30-day postoperative mortality rate was 1% of total 200 patients; both of these 2 patients were in group A. However, this observation had no statistical significance. No intraoperative complications were encountered in either group. The overall 30-day postoperative morbidity rate was 27% (54 of 200) for both groups. The 30-day postoperative morbidity rates in groups A and B were 28% (28 of 100) and 26% (26 of 100), respectively. However, these differences between the groups had no statistical significance importance.

Conclusion

Age alone should not be considered to be more of a contraindication or a worse predictor than other factors for the outcome after colorectal surgery on elderly patients.

Citations

Citations to this article as recorded by

Preoperative management in octogenarian patients with rectal cancer
Arthur M. Damasceno, Rubens Kesley, Marcus Valadão, Fabrício Braga, Cristiane A. D'Almeida, Marcos B. Pitombo
Heliyon.2025; 11(1): e41469. CrossRef
Predictors of complicated course of perioperative period in patients with rectal cancer and rectosigmoid junction
E. P. Kulikov, S. A. Mertsalov, N. I. Verkin, Yu. D. Kaminskiy, I. S. Pikushin
Experimental and Clinical Gastroenterology.2023; (10): 77. CrossRef
Oncological and surgical outcomes of radical surgery in elderly colorectal cancer patients with intestinal obstruction
Qingbiao Ma, Hongyu Li, Yujuan Jiang, Yingfei Wang, Jianwei Liang
Frontiers in Surgery.2023;[Epub] CrossRef
Efficiency of pre-operative preparation of intestines at treatment of sharp intestinal impassability tumoral genesis
H. Sh. Nazarov, Sh. К. Nazarov, N. Sh. Hasanov
Health care of Tajikistan.2022; (2): 59. CrossRef
Before-and-After Study of the First Four Years of the Enhanced Recovery after Surgery (ERAS®) Programme in Older Adults Undergoing Elective Colorectal Cancer Surgery
Cristina Martínez-Escribano, Francisco Arteaga Moreno, David Cuesta Peredo, Francisco Javier Blanco Gonzalez, Juan Maria De la Cámara-de las Heras, Francisco J. Tarazona Santabalbina
International Journal of Environmental Research and Public Health.2022; 19(22): 15299. CrossRef
Perioperative score for octogenarian patients eligible for rectal cancer surgery
Arthur Mota Damasceno, Rubens Kesley, Bruno Souza Paolino, Marcelo Rubens dos Santos do Amaral, Marcos Bettini Pitombo
Journal of Surgical Oncology.2021; 124(8): 1409. CrossRef
Prehabilitation: finally utilizing frailty screening data
Francesco Carli, Amal Bessissow, Rashami Awasthi, Sender Liberman
European Journal of Surgical Oncology.2020; 46(3): 321. CrossRef
Video‐assisted anal fistula treatment for complex anal fistula: a long‐term follow‐up study
G. Giarratano, M. Shalaby, C. Toscana, P. Sileri
Colorectal Disease.2020; 22(8): 939. CrossRef
New prognostic risk score for predicting in-hospital mortality in geriatric patients undergoing colorectal cancer surgery: U.S. Nationwide Inpatient Sample analysis
Xiaohong Zhao, Yunmei Yang, Haifeng Gu, Wenjing Zhou, Qin Zhang
Journal of Geriatric Oncology.2020; 11(8): 1250. CrossRef
Impact of ASA-score, age and learning curve on early outcome in the initiation phase of an oncological robotic colorectal program
Hülya Sarikaya, Tahar Benhidjeb, Sergiu I. Iosivan, Theodoros Kolokotronis, Christine Förster, Stephan Eckert, Ludwig Wilkens, Alaa Nasser, Sebastian Rehberg, Martin Krüger, Jan Schulte am Esch
Scientific Reports.2020;[Epub] CrossRef
Prediction of overall survival following colorectal cancer surgery in elderly patients
Isaac Seow-En, Winson Jianhong Tan, Sreemanee Raaj Dorajoo, Sharon Hui Ling Soh, Yi Chye Law, Soo Yeun Park, Gyu-Seok Choi, Wah Siew Tan, Choong Leong Tang, Min Hoe Chew
World Journal of Gastrointestinal Surgery.2019; 11(5): 247. CrossRef
Health-Related Quality of Life in Older Adults with Colorectal Cancer
Evan Lapinsky, Lillian C. Man, Amy R. MacKenzie
Current Oncology Reports.2019;[Epub] CrossRef
Evaluation of short-term outcomes of laparoscopic-assisted surgery for colorectal cancer in elderly patients aged over 75 years old: a multi-institutional study (YSURG1401)
Keisuke Kazama, Toru Aoyama, Tsutomu Hayashi, Takanobu Yamada, Masakatsu Numata, Shinya Amano, Mariko Kamiya, Tsutomu Sato, Takaki Yoshikawa, Manabu Shiozawa, Takashi Oshima, Norio Yukawa, Yasushi Rino, Munetaka Masuda
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Colorectal Surgery in Elderly Patients
Byung Chun Kim
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