This review addresses the range of treatments suggested to be of contemporary value in the treatment of constipation with critical evaluation of efficacy data, complications, patient selection, controversies and areas for future research. Resection-rectopexy, stapled prolapsectomy, mesh procedures, rectocele repair, stapled rectal resection and anterograde enema are among the reported procedures, but none of them showed a clear superiority over the others due to the lack of prospective randomised trials. Both open and laparoscopic interventions have been used. The outcome is usually positive in the short-term, but long term follow up showed that most procedure carry a high recurrent rate, possibly because the target of surgery is represented by the evident organic lesions, whereas the occult functional causes tend to be underestimated. In conclusion, the authors recommend a strict and selective surgical policy when dealing with patents suffering from evacuation disorders.