Abstract: Transanal total mesorectal excision is a new surgical procedure which has emerged in the recent years. This procedure performs a “bottom-to-up” resection of the rectum and its surrounding mesenteries through the anus, which provides better view compared with laparoscopic or open total mesorectal excision. However, it is undeniable that as a new surgical procedure, transanal total mesorectal excision is also bound to have some complications of surgery. Therefore, how to prevent and treat the complications of transanal total mesorectal excision is still a problem that must be faced in the future. This article intends to review the prevention and treatment of surgical complications and provide some experience for the development of transanal total mesorectal excision.