Surgical indications and precautions for endorectal prolapse: (1) the best surgical indication is rectal prolapse to the anal canal or double endorectal prolapse when severe endorectal prolapse is diagnosed by fecal imaging; (2) surgical indications should be strictly controlled, and surgery should be considered only after strict non-surgical treatment is ineffective; (3) preoperative pelvic quadruple imaging can understand whether endorectal prolapse is combined with pelvic floor hernia, bladder prolapse and uterine (3) preoperative pelvic quadruple imaging can understand whether the prolapse is combined with pelvic floor hernia, bladder prolapse and uterine prolapse, so as to understand the entire morphological changes of the pelvis and provide an objective basis for the selection of surgical methods; (4) anal manometry can understand the function of the anal sphincter and rectal sensory function, with emphasis on understanding whether there is pelvic floor muscle spasm, and if combined with pelvic floor muscle spasm, simple rectal prolapse surgery cannot be performed; (5) normal colonic transmission test. The surgical treatment of endorectal prolapse includes transanal surgery and transabdominal rectal fixation. (1) Transanal surgical methods: including interrupted rectal mucosal suture, sclerotherapy, transanal anastomotic clutch rectal mucosal loop (PPH), transanal anastomotic clutch proctocolectomy (STARR). The advantage of transanal surgery is that it is less invasive and easily accepted by patients, and should be performed as the first. Currently, PPH and STARR are mainly adopted among the above-mentioned surgical methods. Deng Yewei et al [15] used PPH with rectal mucosal relaxation columnar ligation to treat 43 patients with endorectal mucosal prolapse, and the recurrence rate was significantly lower than that of PPH alone 6 to 12 months after surgery. Zhou Zhengxuan et al [16] treated 24 patients with endorectal mucosal prolapse, entropion and/or rectal prolapse using STARR surgery with a mean follow-up of 38 months (9-68 months) and a 61.1% improvement in constipation symptoms. In the European STARR Collaborative Group, 2,224 patients were followed up for 1 year after surgery and showed significant improvements in exit obstruction-type constipation scores (15.8 versus 5.8, P<0.001), symptom severity scores (15.1 versus 3.6, P<0.001), and constipation symptoms compared to preoperative [17].Schwandner and Fürst [18] used the STARR procedure treated 379 cases of obstructive bowel disorders and at 6 and 12 months after surgery, symptom severity scores, bowel obstruction symptom scores and quality of life PACC.QoL scores were significantly lower than preoperatively, 7.34 and 6.59 vs. 13.02 (P<0.001), 6.43 and 6.45 vs. 11.14 (P<0.001), 0.83 and 0.63 vs. 1.37 (P<0.001). (2) Transabdominal rectal fixation: the fixation of the rectum when using this surgical method should first be chosen as unilateral fixation of the rectum, so that the rectum retains a certain degree of mobility and prevents the occurrence of intestinal obstruction [19,20]. According to the results of pelvic quadruple imaging, the abnormalities of pelvic floor morphology should be corrected at the same time during transabdominal surgery, such as performing pelvic floor elevation to eliminate pelvic floor hernias, performing round ligament shortening to correct retroversion of the uterus [19,20], and performing partial sigmoid colectomy in cases of redundant sigmoid colon. Laparoscopic transabdominal rectal fixation was used to treat endorectal prolapse, further reducing the degree of surgical trauma. Li Chunxuan et al [20] reported 30 cases of endorectal prolapse treated by functional transabdominal rectal suspension with 22 cases followed up for 6 months to 10 years, with 77.8% relief of dyspareunia and 61.1% relief of dyspareunia.Collinson et al [21] treated 75 patients with endorectal prolapse by laparoscopic rectal fixation, and 86% ( 56/65) patients had improved symptoms of obstructive defecation and 85% (50/59) patients had improved symptoms of fecal incontinence. Although the domestic and international literature reports that transanal or transabdominal surgery has good efficacy in the treatment of endorectal prolapse, a significant proportion of patients still have poor outcomes after surgery, and the efficacy of surgery gradually decreases with prolonged postoperative time. Therefore, surgical treatment of endorectal prolapse should be strictly controlled when using surgical indications, and conservative treatment should be continued after surgery.