Constipation is a group of symptoms, including difficulty in passing stool, prolonged bowel movement, no bowel movement, significantly reduced frequency of bowel movement, or frequent bowel movement, but each stool volume is small with a sense of incomplete bowel movement, stool can be dry and hard or soft, and may be accompanied by anorectal swelling, etc. Constipation is a symptom or a disease, academic circles are still controversial. In the author’s opinion, constipation with a clear etiology can be counted as a symptom, such as: cancerous intestinal obstruction, metabolic and central nervous disease secondary, megacolon, etc.; functional intractable constipation with unclear etiology should be classified as a disease, which is more conducive to the study of its pathogenesis and facilitate clinical targeting treatment. For functional intractable constipation, the Rome III criteria are usually used internationally as the diagnostic basis, see Table 1. in the author’s opinion, the important significance of the Rome III criteria is to standardize the entry criteria for the diagnosis of chronic constipation. However, surgical treatment of chronic constipation requires that precise diagnosis and subtype diagnosis should be achieved in order to achieve individualized surgical protocols, which is also necessary to maximize efficacy and reduce overtreatment. To achieve an accurate diagnosis of chronic constipation subtypes, it is also necessary to rely on a series of clinical examinations such as fecography, pelvic multiplex, magnetic resonance fecography, whole bowel transmission test and anorectal manometry. Preoperative evaluation of patients with STC should have at least evidence of slowed colonic transmission, otherwise it would be irresponsible to perform total or subtotal colectomy. Adult megacolon should also be excluded by barium enema and anorectal manometry. The clinical symptoms of adult megacolon disease are often atypical and are highly likely to be missed and misdiagnosed, leading to reactive treatment. For patients with OOC, on the basis of meeting the Rome III criteria, it must be clarified through a series of examinations whether they belong to flaccid constipation (pelvic floor prolapse, rectal prolapse, rectal prolapse, etc.) or spastic constipation (puborectal muscle syndrome, pelvic floor spasm syndrome). The two types of OOC are very different in terms of treatment philosophy and approach. In particular, spastic constipation also requires vigilance for possible concomitant pubic nerve compression symptoms. In the case of mixed constipation, which has the characteristics of both types of constipation mentioned above, it is more important to carefully determine clinically from the symptoms and examination whether the cause of the patient’s main symptoms is slow transmission or obstruction at the exit. For STC, the surgical procedures reported in the literature include: total colectomy ileorectal anastomosis (IRA), subtotal colectomy cecum or ascending colorectal anastomosis, ileorectal short-circuit surgery and colonic open surgery. Among them, total colectomy is the mainstream procedure for STC, with a success rate of 80% to 100%. The results of the 11-year follow-up of 110 patients at the Mayo Clinic in the United States showed that 85% of the patients were satisfied with the surgical results. In recent years, both domestic and international literature has concluded that cecum or ascending colorectal anastomosis has better results and solves the problem of diarrhea, with a satisfaction rate of 79%. Studies have shown that both IRA surgery after total colectomy and cecum-rectal anastomosis after subtotal colectomy have good results and should be clinically individualized according to the patient’s condition. Diarrhea after total colectomy is not a problem that needs to be considered. Studies at Chongqing Daping Hospital have shown that at 3-6 months after surgery, 90% of patients have 3-6 bowel movements per day, which is perfectly acceptable for constipated patients despite irregular bowel movements. Cis-colonic irrigation (ACE) can be an alternative to colonic resection or enterostomy, especially for elderly patients or those who cannot tolerate surgery. The few reported cases of successful colonic agenesis and ileorectal anastomosis await further clinical exploration. In the last decade, the use of minimally invasive laparoscopic techniques and single-port laparoscopic techniques in the treatment of STC has been recognized, and for benign disease, minimally invasive techniques are worth advocating. It is worth noting that if STC is accompanied by more pronounced OOC, it should be managed intraoperatively at the same time. OOC includes two major categories: spastic constipation and flaccid constipation, and the former is generally recommended to be treated by non-surgical methods such as anal dilation, biofeedback, and closed injection. Loose constipation, such as anterior rectal protrusion, endorectal prolapse, pelvic floor prolapse or pelvic floor hernia, often coexist or are mutually causal, and the choice of surgical approach should be considered in a comprehensive manner. Surgical repair is often required when the symptoms of anterior rectal prolapse are obvious and one of the following three conditions exists: (1) depth greater than 3 cm; (2) barium residue in the pouch of the prolapse is found on fecal imaging; (3) finger-assisted defecation is often required. Common surgical procedures include transabdominal repair, transvaginal repair, transanal repair, and transperineal repair, with anatomical cure rates ranging from 76% to 100%. Surgery for pelvic floor prolapse or rectal prolapse includes two major types of procedures: transabdominal suspension and transanal resection. There are various types of transabdominal or laparoscopic suspension and fixation procedures, including Ripstein fixation and Orr suspension. It is controversial whether rectal fixation is accompanied by freeing the rectum and removing the long sigmoid colon. Transanal surgery has evolved from the early Delorme procedure and Altemeier procedure to the anastomotic suprahemorrhoidal mucosal loop stapling (PPH) and transanal anastomotic proctocolectomy (STARR), each with its own advantages. However, some studies have concluded that the STARR procedure has a high rate of constipation recurrence and complications. Pelvic floor prolapse or pelvic floor hernia accompanied by total rectal prolapse requires, in principle, a transabdominal operation, especially to elevate and repair the pelvic floor and to fix the uterus, in addition to suspending the rectum. Overall, the surgical satisfaction rate of OOC is generally lower than that of STC patients. In conclusion, there are more surgical modalities for chronic intractable constipation, and there is a lack of clinical studies supported by higher-level evidence, so the surgical options can only be selected clinically on an individual basis. The Rome III criteria are used for diagnosis and cannot be used to determine the severity of the disease or the effectiveness of treatment. There is no authoritative standard at home and abroad to assess the efficacy of postoperative constipation. Generally, the efficacy is judged by comparing the change of stool properties, frequency of defecation, defecation time and improvement of related symptoms before and after treatment, including the satisfaction rate (subjective feeling) of patients. Scales that reflect changes in constipation symptoms and quality of life are important for the evaluation of disease treatment. At present, there are many scales related to constipation, some of which are self-designed, have not been tested for reliability and responsiveness, and can only be used for research exploration. Constipation scales are divided into 3 main categories: (1) The first category is a stool form scale, called the Bristol stool form scale (BSFS); this scale classifies stool form from thin to dry into 7 categories, indirectly reflecting the speed of intestinal transit time through the score of each category. (2) The second category is the evaluation scale of constipation-related symptoms, commonly used are: constipation assessment scale (CAS), constipation scoring system (cleveland clinic score, CCS), Knowles-Eccersley-Scott symptom score ( knowles-eccersley-scott-symptom (KESS), patient assessment of constipation symptom (PAC-SYM), obstructed defecation syndrome score (ODS), bowel function index (BFI), Chinese constipation questionnaire, and the Wexner constipation score. All of these scales are used to determine the severity of constipation by scoring each constipation-related symptom according to the level of the score. (3) The third category is constipation-related quality-of-life assessment scales. The SF-36, patient assessment of constipation quality of life questionnaire (PAC-QOL), constipation related quality of life score (CRQOL), constipation related disability scale (CRDS), etc. are commonly used at present. These scales can indirectly reflect the quality of life of patients affected by constipation according to their scores. Unfortunately, among the above constipation scales, none of them can fully cover the common clinical symptoms of constipation, such as the degree of effort to defecate, the feeling of incomplete defecation, rectal obstruction, hand-assisted defecation, and anal swelling. This may be related to the different original intention, focus, and purpose of each scale design. For example, the KESS score is mainly used to distinguish different types of constipation, and the ODS score is mainly for outlet obstructive constipation, etc. Therefore, a unified standard and consensus are needed for the assessment and determination of the efficacy of postoperative constipation. The dawn of basic research and translational medicine Since the era of the first case of colectomy for constipation, the research on the pathogenesis has never stopped. Studies have found abnormalities in intermuscular ganglion cells, abnormalities in enteric neurotransmitters or abnormalities in Cajal interstitial cells, but none of them could elucidate the mechanism in essence. Some research results have been translated into clinical applications, such as drugs like prilucapride. In recent years, exciting preliminary results have been obtained regarding the application of sacral neuromodulation and electrical stimulation, especially electrical stimulation at acupuncture points such as the foot San Li, in the treatment of constipation. The study of intestinal microecology and sensory neuromodulation mechanisms in constipated patients are exactly the current hot spots of research. It is believed that more translational medicine results will be applied to the clinic in the future to further improve the comprehensive efficacy of constipation.