Role of Modified and Extended Anorectal Myomectomy and Transanal Endosurgical Procedures as Diagnostic and Therapeutic Armamentarium in Congenital and Acquired Colorectal Motility Disorders: A Narrative Review

Abstract Objectives: To synthesise current evidence on modified and extended anorectal myomectomy and transanal endosurgical procedures as diagnostic and therapeutic tools in congenital and acquired colorectal motility disordersand to clarify their role alongside manometry, radiology, and histopathology in contemporary clinical practice [1-4]. Design: Narrative review. Data Sources: Peer-reviewed literature from PubMed, MEDLINE, Embase, and major colorectal and paediatric surgical journals, including studies on Hirschsprung disease, hypoganglionosis, internal anal sphincter achalasia, dyssynergic defecation, anorectal manometry, and transanal endosurgical platforms (TEM, TAMIS, robotic TAMIS). Eligibility Criteria: Studies describing diagnostic evaluation, histopathology, surgical technique, or clinical outcomes related to anorectal myomectomy or transanal endosurgeryin paediatric or adult colorectal motility disorders. Data Extraction and Synthesis: Evidence was synthesised thematically across four domains: (1) disorder spectrum and pathophysiology, (2) diagnostic limitations of manometry and radiology, (3) technical evolution of myomectomy and transanal endosurgery, and (4) therapeutic outcomes and patient selection. Emphasis was placed on transition zone pathology, hypoganglionosis, and functional outlet obstruction Results: Modified and extended anorectal myomectomy provides both diagnostic clarity and functional decompression in selected motility disorders, particularly where non-invasive tests are inconclusive. Extended myomectomy enhances histopathological yield, enabling differentiation between hypoganglionosis, internal anal sphincter achalasia, and transition zone abnormalities. Extended myomectomy improves diagnostic accuracy by enabling full-thickness sampling of the enteric nervous system[7, 11, 12]. Myomectomy also provides functional benefit by relieving distal muscular obstruction[11-14]. Transanal endosurgical platforms (TEM, TAMIS, robotic TAMIS) offer precise, minimally invasive access for targeted myotomy and biopsy [15-19]. Integrating these modalities with physiological and radiologic assessment supports a unified diagnostic–therapeutic workflow.Across studies, symptom improvement, reduced obstructive episodes, and preservation of continence were consistently reported in appropriately selected patients. Conclusions: This narrative review synthesised current evidence on modified and extended anorectal myomectomy and transanal endosurgical procedures in the diagnosis and management of colorectal motility disorders. Modified/extended anorectal myomectomy and transanal endosurgery are valuable adjuncts in the diagnostic and therapeutic pathway for complex colorectal motility disordersTheir integration with manometry, radiology, and structured histopathology can refine diagnosis, guide personalised intervention, and improve functional outcomes. Standardised protocols and prospective studies are needed to optimise patient selection and define long-term efficacy.