Gender-specific Differences in Preoperative Characteristics and Perioperative Outcomes of Patients Undergoing Robotic Resection Rectopexy With NOSE for Obstructive Defecation Syndrome

PURPOSE: Obstructive defecation syndrome (ODS) significantly impairs bowel function and often requires surgical intervention. This study evaluated sex-specific differences in outcomes after robotic-assisted resection rectopexy with natural orifice specimen extraction (NOSE). METHODS: A prospective cohort of 57 patients (46 females, 11 males) undergoing robotic NOSE rectopexy for ODS was analyzed. Functional outcomes were assessed using the Wexner Constipation Score (WCS), Incontinence Score (WIS), and Altomare OD Score at baseline, 1, 3, and 12 months. To account for unequal group sizes, entropy balancing was applied and weighted analyses were performed. RESULTS: Descriptive data indicated that rectocele was more frequent in females (73.9% vs. 27.3%), and male patients had slightly longer hospital stays (6.0 vs. 4.6 d). Constipation, ODS, and incontinence scores improved markedly in both sexes (eg, WCS at 12 mo: 2.0 in males vs. 4.8 in females). While raw values suggested somewhat faster improvement in males, weighted analyses confirmed that no significant sex effects remained. No conversions or anastomotic leaks occurred, and overall patient satisfaction was high (96.5%). CONCLUSION: Robotic NOSE rectopexy provides safe and effective treatment for ODS in both sexes. Descriptive analyses suggested a trend toward faster recovery in male patients, but after adjustment with entropy balancing no significant sex effects were found. Both sexes experienced marked functional improvement and high satisfaction, supporting robotic NOSE rectopexy as a valuable treatment option.