Persistent constipation is a common syndrome. With the changes in social habits and dietary structure, the incidence of constipation has been increasing year by year in recent years. The lack of attention to the early stage of the disease and the lack of standardization of diagnosis and treatment are the main reasons affecting the long-term therapeutic effect. 1, the standardized diagnosis of intractable constipation In recent years for the colon, rectum, pelvic floor anatomy and physiology and the diagnosis and treatment of constipation research (such as colon transport function test, fecal imaging, anal manometry, pelvic floor electromyography, water bladder forcing out the test and other etiological diagnostic aspects) has made significant progress. However, in the diagnosis of constipation choice is relevant. 2, non-surgical standardized treatment of intractable constipation furuncle Intractable constipation is generally benign functional disease, such as no complications, constipation itself is not life-threatening, so non-surgical treatment (laxatives, behavioral therapy, biofeedback therapy, etc.) is the first choice of intractable constipation, laxatives are an important part of non-surgical treatment of patients with constipation, but it should not become a single means. At present, the clinical abuse and irregular use of laxatives has become a “tumor” in the treatment of patients with constipation, leading to the failure of non-surgical treatment of patients for important reasons. Clinical should be strictly according to the Rome III standard, the patient using graded drug therapy, including fiber preparations for the first-line drugs, volumetric laxatives for the second-line drugs, osmotic laxatives for the third-line drugs, stimulating laxatives and intestinal dynamics of the drug for the fourth-line drugs. Our preliminary study found that patients with constipation are often associated with intestinal flora disorders, and chronic inflammation of the colonic mucosa plays an important role in the development and progression of constipation. Dietary fiber combined with probiotics and glutamine complement each other in terms of efficacy and have a pharmacodynamic enhancement effect on each other. Therefore, in clinical practice, we use dietary fiber and probiotics as the first-line drugs for constipation treatment. Biofeedback therapy refers to understanding the patient’s defecation behavior through surface electromyography of the patient’s anal and pelvic floor muscle activity, anal canal pressure receptors, and anal fingerprinting by the therapist, and then learning how to appropriately use the abdominal muscles to increase the intra-abdominal pressure and to relax the pelvic floor muscles to reduce the outlet obstruction to complete the defecation process under the guidance of the therapist. For outlet obstruction type constipation caused by pelvic floor muscle movement incoordination and pelvic floor relaxation syndrome, biofeedback therapy has the advantages of simplicity, non-invasiveness, no side effects, repeatable treatment, easy acceptance, low treatment cost, and outpatient treatment. However, the effect of applying biofeedback therapy alone is not good, and foreign countries report that the effective rate is only about 30%. If the biofeedback therapy and drug grading therapy are jointly applied, it is expected to further improve the therapeutic effect. Due to the disease characteristics of constipation, such as patients are often accompanied by different psychological disorders, seasonal episodes, easy to aggravate when tired, etc., to ensure the sustainability of non-surgical treatment of constipation patients and systematic is an important factor to improve the effect of non-surgical treatment. Therefore, doctors should pay attention to sustainable treatment in addition to disease factors when making treatment plans. Conditional medical institutions should establish a database of intractable constipation, set up a follow-up system, urge patients to adhere to the treatment program, while recording the efficacy of treatment, analyze the reasons for treatment failure, and strictly implement the principle of graded treatment and individualized comprehensive treatment. 3, standardized surgical treatment of intractable constipation Surgical intervention is the last resort after the failure of non-surgical treatment of intractable constipation. Surgical intervention is the last resort after the failure of non-surgical treatment of intractable constipation. Before surgical treatment, surgeons should fully recognize the diversity of clinical symptoms of different constipated patients, and their underlying pathophysiological changes are different. Constipation is a functional disease and is not life-threatening without complications. Patients turn to surgery to improve their quality of life and have high expectations of surgical outcomes. Therefore, caution must be exercised before performing surgical treatment that may be irreversible. The severity of clinical symptoms and underlying physiologic abnormalities should be thoroughly evaluated in each case to develop a targeted surgical plan. In order to achieve good postoperative defecation and fecal control function of the patient, and at the same time, it is required to avoid the occurrence of various complications. The surgical treatment of intractable constipation is a relatively difficult problem for clinicians, and medical disputes due to unsatisfactory treatment results or surgical complications are common. The reason for this is often not a technical error in surgical operation, but mostly due to improper choice of surgical style. The use of colectomy or total colectomy for the treatment of constipation was reported in the literature in 1908, and after 1984, the indications for colectomy for the treatment of constipation began to be limited to patients diagnosed with slow-transmission constipation. The use of this procedure peaked in the early 1990s. It is now generally accepted that colectomy should only be performed in patients with a confirmed diagnosis of slow-transmission constipation that severely affects quality of life and fails to improve symptoms with non-surgical treatments.A 1999 Meta-analysis systematically reviewed the efficacy and complications of colectomy, with a total of 32 case-control studies (12-106 cases) providing information on the efficacy of this procedure. The overall patient satisfaction rate was 86%. The most common postoperative complication was small bowel obstruction with a mean incidence of 18% and a corresponding reoperation rate of 14%. Abdominal pain continued to be a complaint in 41% of patients after surgery. Permanent ileostomy is required in 5% of patients, mainly due to poor bowel function after surgery, especially diarrhea, fecal incontinence or recurrence of constipation. There are several types of outlet-obstructive constipation, of which anterior rectal protrusion and endorectal intussusception are the most common. Various conventional surgical approaches, including transvaginal, perineal, anal or combined transabdominal surgery, are associated with imprecise long-term outcomes and high complication and postoperative recurrence rates. As a result, none of the surgical procedures has significant advantages and can be widely used in the clinic for a long time. Since the invention of the loop anastomosis in the 1980s, the use of loop anastomosis for the treatment of outlet obstruction constipation has become a clinical hot spot. Transanal anastomotic rectal resection (STARR) is performed to improve rectal function by removing redundant rectal tissues. The mechanism is still unclear, and it may promote defecation by improving rectal compliance and sensory ability. The advantages of this procedure are that it is less invasive, easier to perform, and less painful postoperatively. It is easily accepted by patients, and it has even been performed in some patients with outlet obstruction type of defecation without clear anatomical abnormality of the rectum, and it is important to be alert to the tendency of its misuse. For mild or simple endorectal prolapse with outlet-obstructed defecation, the immediate results of this procedure are good. However, in severe outlet-obstructive constipation, the pathologic basis of which is pelvic floor laxity, rectal mucosal prolapse may be only one of many pathoanatomical changes, especially when combined with slow-transmission constipation, the efficacy of this procedure is limited, and the recurrence rate is high. A high percentage of patients may have serious postoperative complications (e.g., anastomotic fistula, rectal stenosis, etc.); therefore, further research is needed to clarify the criteria for case selection and long-term efficacy of this procedure. It should be emphasized that patients with constipation should be cautious of anorectal surgery, once the anatomy and physiology of the anorectum is changed, and the symptoms are not relieved, it is difficult to perform remedial surgery. Based on the above understanding, we have innovated the surgical treatment of intractable mixed constipation, i.e., subtotal resection of the colon to relieve the cause of slow transmission, and at the same time perform lateral anastomosis of the ascending colon and rectum (posterior wall) to correct the anatomical and functional disorders of the pelvic floor and thus relieve the cause of outlet obstruction. We named this procedure as Jinling procedure. So far, more than 800 cases have been performed, and the follow-up study shows that the near and long-term efficacy of this procedure is satisfactory. The role of enterostomy in the surgical treatment of constipation should not be ignored. The role of enterostomy in the surgical treatment of constipation is: (1) as a definitive surgical procedure. (2) To guide further treatment. (3) As a rescue measure in case of failure of other surgical treatments or complications. As a definitive therapeutic measure, enterostomy has been used in a wide variety of adult and pediatric patients characterized by defecation difficulties, including spinal cord injury, megacolon, and outlet obstruction. There is no evidence to support the choice of colostomy or ileostomy, with numerous postoperative complications after ileostomy and sometimes less favorable outcomes after colostomy. Minimally invasive techniques such as laparoscopy and robotics have been widely used in other areas of colorectal surgery, but there are fewer relevant reports in the field of surgical management of constipation. The main problem that currently limits the use of laparoscopy in constipation surgery is the high incidence of postoperative adhesive bowel obstruction. The main technical difficulty in laparoscopic subtotal colectomy is the freeing of the hepatic and splenic flexures, and patients with constipation tend to have a redundant and twisted colon and an elevated splenic flexure, which increases the difficulty of laparoscopic surgery. Laparoscopic surgery has a technological development curve with the accumulation of the number of cases, and we established a specialized group for the surgical treatment of constipation in 2007. After completing 100 cases of laparoscopic jinling surgery, there was no significant difference in the surgical operation time from that of open surgery. And large amount of saline irrigation of the abdominal cavity is the most effective measure to prevent postoperative adhesive bowel obstruction. It is believed that minimally invasive surgery will play a more important role in the treatment of constipation with the further rationalization of constipation surgery and the development of laparoscopic technology.