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Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer in the United States and it is found in 17% of patients thought to have complicated diverticular disease. However, primary adenocarcinoma rarely occur in the colostomy site and the risk of developing malignancy is similar to that of any other colonic segment. Polyps found in CRC screenings can be divided into the following types: hyperplastic polyps, polyps with no malignant potential, adenomatous polyps, polyps with malignant potential, and malignancies. Local complications of the colostomy can appear in the immediate, early, or late postoperative period, with an incidence ranging from 15 to 30%; neoplasia is even less common. (AU)

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In this study, we describe, compare, and discuss several subcellular alterations found in Colorectal Adenocarcinoma and peritumoral tissue using transmission electron microscopy, morphometry, and statistical analysis. Tissue samples from anterior resections were collected from patients diagnosed with Colorectal Adenocarcinoma in the University Hospital of Caracas. Samples were processed according to the typical protocol for their observation through transmission electron microscopy. The resulting images were analyzed using specialized software for the collection of morphometric data. Several anomalies were common for both tissues, including but not limited to, rough endoplasmic reticulum and mitochondrial swelling, nuclear invagination, nuclear enlargement, and cellular swelling. In general, alterations within the tumor were more frequent and intense. Extensive organellar degradation and other evidences of cellular damage seemed to extend past the edge of the tumor into the peritumoral tissue. There seems to be a clear process of lateral cancerization present in the peritumoral area. The tissue layers composed of smooth muscle cells, probably due to their structural features, may allow greater diffusion of harmful substances produced by the tumor. A more in-depth analysis of peritumoral tissue considering organellar damage and morphometric data may provide relevant insight about the changing microenvironment promoted by the close proximity of a tumor.

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ABSTRACT Objective: Transanal repair of rectocele and full rectal mucosectomy with one circular stapler is a procedure designed for the treatment of Obstructive Defecation Syndrome by doctor Fco. Sergio Regadas in 2005. We compare the use of multiple instruments and their mechanical technology effect in the treatment of anorectocele. Patients and methods: Female patients complaining about sensation of incomplete evacuation, ages between 40 and 55. The evaluation was made with the function of evacuation protocol: colonic transit time, colon radiology, ecodefecography, anorectal manometry and psychological test. The technique used was transanal repair of rectocele and full rectal mucosectomy with one circular stapler, using staplers CPH-34, CPH-34HV and EEA-3135-HEM, with measurement of the rectal wall resected: vertical length in centimetres, horizontal length in centimetres, weight in grams and volume in cubic centimetres; afterwards histological study of the tissue thickness, and applied the ANOVA and SPSS 12 tests for the statistical analysis. Results: The results obtained by comparing the resections made with the CPH-34, the CPH-34HV and the EEA-3135-HEM in respect of vertical length, horizontal length, weight and volume, were found to have no significant differences; neither in the histological study of the tissue thickness in respect of characteristics and structure. Conclusion: The effect of mechanical technology in the treatment of anorectocele with transanal repair of rectocele and full rectal mucosectomy with one circular stapler procedure using the CPH-34, the CPH-34HV and the EEA-3135-HEM, does not show any difference. Leaving the application of each to the operator competencies.

RESUMO Objetivo: TRREMS (Transanal Repair of Rectocele and full rectal Mucosectomy with one circular Stapler, Reparo transanal de retocele e mucosectomia retal total com um grampo circular) é um procedimento que visa o tratamento da Síndrome da Defecação Obstrutiva pelo Dr. Francisco Sergio Regadas em 2005. Comparamos o uso de diversos instrumentos e o efeito mecânico da tecnologia no tratamento da anorretocele. Pacientes e métodos: Pacientes do gênero feminino com queixa de sensação de evacuação incompleta (SEI), com idades entre 40 e 55 anos. A avaliação foi efetuada com o protocolo de função de evacuação: tempo de trânsito colônico, radiologia do cólon, ecodefecografia, manometria anorretal e teste psicológico. A técnica empregada foi TRREMS, com o uso de grampeadores CPH-34, CPH-34HV e EEA-3135-HEM, com medição da parede retal ressecada: comprimento vertical em centímetros, comprimento horizontal em centímetros, peso em gramas e volume em centímetros cúbicos; subsequentemente, foi realizado estudo histológico da espessura do tecido, com aplicação de ANOVA e do programa SPSS 12 para a análise estatística. Resultados: Observamos que os resultados obtidos com a comparação das ressecções realizadas com CPH-34, CPH-34HV e EEA-3135-HEM com relação ao comprimento vertical, comprimento horizontal, peso e volume, bem como os resultados do estudo histológico da espessura do tecido com relação às características e estrutura, não apresentavam diferenças significativas.

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La secuencia Robin, previamente conocida como síndrome de Pierre Robin, se caracteriza por la presencia de micrognatia o retrognatia, glosoptosis con o sin fisura palatina. Los recién nacidos con este síndrome, pueden presentar obstrucción de la vía aérea, dificultad para la alimentación, retraso del crecimiento e hipoxemia crónica. La mitad de estos pacientes presentan malformaciones asociadas. La incidencia es aproximadamente de 1: 8,500. Las opciones actuales del tratamiento de la obstrucción de la vía aérea en estos pacientes, van desde la posición prona, intubación nasofaríngea, glosopexia con adhesión labial, distracción mandibular hasta la traqueostomía. Se presentó una variante de tratamiento quirúrgico de urgencia realizada a un recién nacido portador de una secuencia Robin con dificultad respiratoria. Se realizó una labio-glosopexia de Routledge. El paciente tuvo una evolución postoperatoria favorable sin dificultades en su ventilación y alimentación.

The Robin sequence, previously known as Pierre Robin syndrome, is charaterized by the presence of micrognathia or retrognathia, glossoptosis with or without cleft palate. The newborns with this syndrome may present airway obstruction, feeding difficulties, growth retardation and chronic hypoxemia. Half of these patients have associated malformations. The incidence is almost 1: 8 500. The current options for the treatment of the airway obstruction in these patients range from prone position, nasofaringeal intubation, glossopexy with lip adhesion, mandibular distraction up to tracheostomy. We presented a variant of emergency surgical treatment carried out in a newborn having a Robin sequence with respiratory difficulty. A Routledge´s lip-glossopexy was made. The patient had a favorable post-surgery evolution in his ventilation and feeding.

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Abstract Objective This study aims to determine changes in the proportions of types I and III collagen in hemorrhoids and to verify the sliding anal canal lining theory. Patients and method The study is focused on a sample of 17 patients, 9 females and 8 males (age range: 30-70 years), with grade III and grade IV hemorrhoids. Tissue from 4 fetuses (age: 16 weeks of gestation) was used as control sample. All the participants gave their informed consent. Samples were gathered in 2014. All patients underwent open hemorrhoidectomy by using the technique described by Milligan and Morgan, published in Lancet journal in 1937. The hemorrhoid samples were stained with hematoxylin-eosin for the histologic study to confirm the hemorrhoidal tissue diagnosis. The picrosirius red staining protocol was used after the histologic analysis. The method used for image processing is described in the text. Images were imported to the Image Tool for Windows software. The same process was used on the embryonic tissue. Data resulting from the analysis of images were processed using STATISTICA, a software for statistical analysis. Results When compared, it was found that the two tissues presented very different values, with hemorrhoids containing the highest type III collagen values. Conclusion Our results seem to imply that hemorrhoids have a larger proportion of type III collagen than fetal tissue. They also suggest a possible age-related deterioration of the tissue.

Resumo Objetivo Esse estudo tem por objetivo determinar mudanças nos percentuais do colágeno dos tipos I e III em hemorroidas e verificar a teoria do revestimento de canal anal deslizante. Pacientes e método O estudo está focado em uma amostra de 17 pacientes (9 mulheres e 8 homes; faixa etária: 30-70 anos), com hemorroidas de graus III e IV. Utilizamos tecido de quatro fetos (idade: 16 semanas de gestação) como amostra de controle. Todos os participantes deram consentimento informado. As amostras foram reunidas em 2014. Todos os pacientes passaram por uma hemorroidectomia aberta; para tanto, foi empregada a técnica descrita por Milligan e Morgan, publicada no periódico Lancet em 1937. As amostras de hemorroida foram coradas com hematoxilina-eosina com vistas ao estudo histológico para confirmação do diagnóstico de tecido hemorroidal. Após a análise histológica, o material foi corado com o protocolo de picrosirius red. O método empregado para o processamento das imagens está descrito no texto. As imagens foram importadas pelo software Image Tool for Windows. O mesmo processo foi empregado no tecido embrionário. Os dados resultantes da análise das imagens fora processados com o programa STATISTICA, um software para análise estatística. Resultados Por comparação, constatamos que os dois tecidos apresentavam valores muito diferentes, e as hemorroidas continham os mais altos valores de colágeno do tipo III. Conclusão Nossos resultados parecem implicar que hemorroidas possuem um percentual mais elevado de colágeno do tipo III versus tecido fetal. Os resultados também sugerem uma possível deterioração do tecido, relacionada à idade.

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Objetivo: Se realiza una revisión de las historias clínicas con el diagnóstico de enfermedad hemorroidal evaluadas en la Unidad de Coloproctología del Instituto Autónomo Hospital Universitario de Caracas durante el período comprendido entre 2006 y 2013, de acuerdo con los datos del Departamento de Estadísticas de Salud del Instituto Autónomo Hospital Universitario de Caracas Métodos: Se trata de un estudio descriptivo, retrospectivo y transversal, que tomó como muestra la totalidad de la población, la cual estará conformada por las historias clínicas de los 585 pacientes que fueron evaluados en la Unidad de Coloproctología con el diagnóstico de enfermedad hemorroidal durante el período enero 2006 hasta diciembre 2013. El tratamiento estadístico se realizó a través un análisis estadístico descriptivo de cada una de las variables del estudio. Para las variables cualitativas se estimó la frecuencia absoluta y porcentajes; para la variable cuantitativa se calculó las medidas de tendencia central. Se utilizó el programa SPSS versión 17 para la realización de la base de datos y tabulación de resultados Resultados: La muestra consistió en 585 historias clínicas pertenecientes a evaluados en la Unidad de Coloproctología del Hospital Universitario de Caracas, en el período comprendido de enero 2006 a diciembre de 2013. De la muestra estudiada, 324 corresponden a sexo femenino y 261 al sexo masculino; por grupos etarios: 11 a 20 años, 14 casos; 21 a 30 años, 69 casos; 31 a 40 años, 126 casos; 41 a 50 años, 152 casos; de 51 a 60 años, 130 casos; 61 a 70 años, 65 casos; 71 a 80 años, 25 casos y de 81 a 90 años, 4 casos, ubicándose la mayoría de los pacientes en el grupo de 31 a 60 años. Según la clasificación de la patología hemorroidal: grado I, 38 casos; grado II, 254 casos; grado III, 247 casos y grado IV, 46 casos. Fueron intervenidos quirúrgicamente 84 pacientes, lo que equivale al 14,35 % de los casos, utilizándose como técnicas el procedimiento de Milligan y Morgan en 46 casos, hemorroidopexia con autosuturadora en 30 casos, Ferguson en 7 casos y Obando en 1 caso. De los pacientes evaluados, 63 pacientes (10,76%) cursaban con fisura anal, 54 con hemorroides trombosadas (9,23%) y 43 con prolapso mucoso (7,35%). Conclusión: La información recolectada puede ser comparada con los estudios de otros autores previamente descritos, obteniéndose resultados similares en algunos aspectos y diferencias pequeñas que podrían ser consideradas como no significativas(AU)

Objective: A review of medical records was performed with the diagnosis of hemorrhoidal disease evaluated in the Colorectal Unit at Instituto Autónomo Hospital Universitario de Caracas, during the period between 2006 and 2013, according to data from its Department of Health Statistics. Methods: This is a descriptive, retrospective and cross-sectional study, which was sampled the entire population, which will consist of the medical records of 585 patients who were evaluated in the Colorectal Unit with the diagnosis of hemorrhoidal disease during the period from January 2006 to December 2013. The statistical analysis was performed using descriptive statistical analysis of each of the study variables. For qualitative variables, the absolute frequency and percentage was estimated; variable for the quantitative measurement of central tendency was calculated. SPSS version 17 for the performance of the database and tabulation of results was used Results: The sample consisted of 585 medical records pertaining to evaluated in the Colorectal Unit, in the period January 2006 to December 2013. In the sample studied, corresponding to 324 females and 261 males, by age groups: 11 to 20 years, 14 cases; 21 to 30 years, 69 cases; 31 to 40 years, 126 cases; 41 to 50 years, 152 cases; of 51 to 60 years, 130 cases; 61-70 years, 65 cases; 71 to 80 years, 25 cases and 81 to 90 years, 4 cases. Most of the patients belonging to the group of 31 to 60 years. According to the classification of hemorrhoidal disease, grade I, 38 cases; grade II, 254 cases; grade III and grade IV 247 cases, 46 casos.Fueron surgically treated 84 patients, equivalent to 14.35% of the cases, using techniques such as the method of Milligan and Morgan in 46 cases, with autosuture hemorrhoidopexy in 30 cases, Ferguson and Obando in 7 cases and in 1 case respectively. Of the patients evaluated, 63 patients (10.76%) with anal fissure were enrolled, 54 thrombosed hemorrhoids (9.23%) and 43 with mucosal prolapse (7.35%). Conclusion: The collected information can be compared with the studies of other authors that previously described similar results in some ways and small differences could be considered as not significant(AU)

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Objetivo: Presentar la aplicación de la tecnología láser en el tra-tamiento de la enfermedad hemorroidal. Estudio realizado en cen-tro privado, y en la Unidad de Coloproctología del HospitalUniversitario de Caracas, Métodos: En el período comprendidoentre junio 2012 y agosto 2013 se estudió un total de 35 pacien-tes todos con problemas hemorroidales con criterios quirúrgicos(sangrado, prolapso, dolor). Del total de pacientes, 7 casos fuerontratados de emergencia y 28 casos fueron electivos. El equipo uti-lizado fue un láser diodo marca Velas de 30W y en una oportu-nidad se utilizó un equipo de láser CO2 DEKA. Los pacientes fue-ron informados previamente sobre la utilización del instrumentalláser, lo cual aprobaron. Se evaluó el tiempo de cirugía, el sangradointraoperatorio y postoperatorio, el dolor postoperatorio, el tiem-po de zicatrización y la reincorporación a las actividades cotidia-nas. Resultados: Se evidenció dolor postoperatorio en un valorde 4 a 6 puntos (tomando como referencia la escala analógica deldolor de 1 al 10) lo cual disminuyó posterior a la primera semanadel postoperatorio. El sangrado intraoperatorio disminuyó alrede-dor de un 80%. El tiempo de cicatrización disminuyó en alrededorde un 50% por lo que la reincorporación a las actividades cotidia-nas fue más temprana (alrededor de la mitad del tiempo que enla cirugía convencional). Conclusión: La tecnología láser es unprocedimiento seguro que puede ser aplicado en el tratamiento dela enfermedad hemorroidal. El tiempo de cicatrización y de rein-corporación a las actividades cotidianas del paciente se reduceprácticamente a la mitad cuando se compara con otros estudiosde hemorroidectomía convencional. La aplicación de tecnologíaláser debe ser realizada por especialistas con dominio del equipoe instrumental(AU)

Objective: To present the application of laser technology in thetreatment of hemorrhoids diseae. A study performed in a privatecenter and at Coloproctology Unit of Hospital Universitario deCaracas. Methods:In a period between June 2012 and August2013, a total of 35 patients were studied with hemorrhoidal pro-blems all surgical criteria (bleeding, prolapse, pain). Of the patients,7 patients were treated as emergency cases and 28 cases wereelective. The equipment used was a laser diode 30W candle brandand on one occasion a team of DEKA laser CO2 was used.Patients were previously reported on the use of laser instrumentswhich passed. We evaluated operative time, intraoperative and pos-toperative bleeding, postoperative pain, healing time and return todaily activities. Results: Postoperative pain was observed in a valueof 4-6 points (base in analogue pain scale 1 to 10) which decre-ased after the first week postoperatively. The intraoperative blee-ding decreased around 80 %. Healing time decreased by about 50% so the return to daily activities was more early (about half thetime than conventional surgery). Conclusion: Laser technology isa safe procedure that can be applied in the treatment of hemor-rhoidal disease. The healing time and return to daily activities ofthe patient is reduced to almost half when compared with otherstudies of conventional hemorrhoidectomy. The application oflaser technology must be performed by domain specialists withequipment and instruments(AU)

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Objetivo: Determinar el tiempo de tránsito colónico (TTC) en pacientes con estreñimiento crónico debido a ciego móvil (CM). Métodos: Estudio descriptivo, prospectivo y transversal don-de se incluyeron todos los pacientes con diagnóstico de estreñimiento crónico y la presencia de ciego móvil que acudieron a la Unidad de Coloproctología del Hospital Universitario de Caracas,entre enero y octubre de 2013. La estadística se desarrolló por el análisis de la varianza ANOVA (Anova de Fisher o Análisis de varianza de Fisher). Resultados: Se incluyeron 33 pacientes, todas mujeres, comprendidas entre los 18 y 75 años, con una media de 46.5 años.Presentaron CM I 6 = 18.2%, CM II 13 = 39.3% y CM III 14 =42.4%. A todas se les practicó TTC con evaluación al quinto día.La retención de marcadores osciló entre 1 y 37. No hubo significancia para el número de marcadores del tiempo de tránsito colónico (TTC) y los tres tipos de ciego móvil (CM). Si fue significativo el número de marcadores del TTC y el segmento de colon corres-pondiente al tipo de CM I=recto, CM II=colon descendente y CM III=ciego. Conclusión: El TTC demuestra que existe tránsito lento en todas las pacientes con CM sin importar el grado, y evidenciando que el CM III presenta la retención en la región inicial de colon,el ciego(AU)

Objective: To determine the colonic transit time (CTT) inpatients with chronic constipation due to mobile cecum (MC). Methods: Descriptive prospective cross-sectional study, where all patients with diagnosis of chronic constipation and the presence of mobile cecum, who attended the Colorectal Unit at Hospital Universitario de Caracas, between January and October 2013 Statistics are developed by ANOVA analysis (ANOVA (Fisher analysis of variance or Fisher variance) Results: We included 33 patients, all women, aged between 18 and 75 years old, with an average of 46.5 years. Presented MCI 6 = 18.2%, MC II 13 = 39.3% and MC III 14 = 42.4%. Be practiced all CTT with evaluation on the fifth day. Retention of markerstilt between 1 and 37. Significance there was for the number of transit time markers colonic (CTT) and the three types of mobilececum (MC). If the number of markers of the CTT was significant and the segment of colon corresponding to the type of MC I =rectum, MC II = descending colon and MC III = cecum. Conclusion: CTT shows that there is slow transit in all patients regardless of the degree MC, and MC III showing that the retention in the initial region of colon, cecum(AU)

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Determinar cuales son los principales síntomas de los pacientes con estreñimiento crónico debido a ciego movil y los resultados postoperatorios al someterse a cecopexia. Estudio descriptivo, prospectivo y transversal donde se incluyeron todos los pacientes con diagnóstico de estreñimiento crónico de tránsito lento (ciego móvil) que acudieron a la Unidad de Coloproctología del Hospital Universitario de Caracas, desde marzo 2007 a marzo 2010, y a quienes se le realizó un interrogatorio (criterios de Roma III, escala de Wexner), examen físico y estudios de protocolo para estreñimiento (tiempo de transito) colónico, eco y/o videodelecografía, cecografía y colonoscopia de ser justificada) para luego ser sometidos a cecopexia. Se incluyeron 52 pacientes, 50 pacientes (96%) mujeres y 2 (4%) hombres en edades comprendidas entre 19 y 62 años. Se aperaron 22 pacientes (44%), a quienes se les evaluó los principales motivos de consulta tales como disminución de la frecuemcia evacuatoria presente en el 100% de los casos, dolor abdominal y heces duras (96%). defecación obstruida (87%), uso excesivo de laxantes (74%), distensión abdominal (65%) y meteorismo (52%) entre otros. Las patologías asociadas más frecuentes fueron hemorroides en 38% de los casos e intususcepción y rectocele en 30%. El tiempo de tránsito colónico preoperatorio fue anormal en todos los casos, ubicándose los marcadores tanto en colon derecho como izquierdo en 57% y 43% sólo en colon derecho el tiempo de tránsito colónico postoperatorio fue normal en el 83% de los casos y en 17% alterado, 9% en colon izquierdo, 4% derecho y 4% ambos. La cecografía preoperatoria fue grado III en 70% de los casos, grado II 26% y grado I 4% modificandose en el postoperatorio 52% normales, 26% grado I, 18% grado II y 4% grado III. De los 22 pacientes operados, 12(57%) se les realizó como procedimiento asociado a la cecopexia una cura de rectocele vía transanal. La escala de Wexner preoperatoria fue de 6 como promedio...

To determine which are the main symptoms of patients with chronic constipation due to mobile cecum and postoperative outcomes to undergo cecopexy. A descriptive atudy, transverse and prospective, where we included all patients with a diagnosis of chronic constipation of slow traffic (mobile cecum) who came to the Coloproctology Unit of Hospital Universitario de Caracas, from March 2007 to March 2010, and who was conducted an interrogation (Roma III, Wexner scale critería), physical examination and studies of protocol for constipation (colonic transit time, ultrasound and/or videodelecography and colonoscopy to be justified) to then be submitted to cecopexy. We included 52 patients, 50 (96%) women and 2 (4%) men aged between 19 and 62 years. Operated 22 patients (44%) who was assessed the main reasons for consulting such as reduction of the evacuatory frequency present in 100% of the cases, abdominal pain and hard stools (96%), obstructed defecation (87%), over use of laxatives (74%), abdominal distention (65%) and meteorism (52%) among others. The most frequent associated diseases were hemorrhoids in 38% of cases and intussusception and rectocele by 30%. Preoperative colonic transit time was abnormal in all cases, placing markers both in right colon as left by 57% and 43% only in right colon postoperative colonic transit time was normal in 83% of cases and 17% altered, 9% in left colon, 4% right, and 4% both, The preoperative cecography was I grade III in 70% of cases, grade II 26% grade I 4%, modifying in postoperative normal 52%, 26% grade I, 18 per cent grade II and 4% grade III. Of 22 operated patients, 12 (57%) was them performed as associated with the cecopexy procedure a rectocele transanal repair. The scale of Wexner was 6 average and 16 postoperative, like the evacuatory frequency which improved on a daily basis by 69 per cent of cases, more than I time a week at 22% and 9% without improvement. The most frequent complications were mild in 48%...

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BACKGROUND: Defecography is the gold standard for assessing functional anorectal disorders but is limited by the need for a specific radiologic environment, exposure of patients to radiation, and inability to show all anatomic structures involved in defecation. Echodefecography is a 3-dimensional dynamic ultrasound technique developed to overcome these limitations. OBJECTIVE: This study was designed to validate the effectiveness of echodefecography compared with defecography in the assessment of anorectal dysfunctions related to obstructed defecation. DESIGN: Multicenter, prospective observational study. PATIENTS: Women with symptoms of obstructed defecation. SETTING: Six centers for colorectal surgery (3 in Brazil, 1 in Texas, 1 in Florida, and 1 in Venezuela). INTERVENTIONS: Defecography was performed after inserting 150 mL of barium paste in the rectum. Echodefecography was performed with a 2050 endoprobe through 3 automatic scans. MAIN OUTCOME MEASURES: The κ statistic was used to assess agreement between echodefecography and defecography in the evaluation of rectocele, intussusception, anismus, and grade III enterocele. RESULTS: Eighty-six women were evaluated: median Wexner constipation score, 13.4 (range, 6-23); median age, 53.4 (range, 26-77) years. Rectocele was identified with substantial agreement between the 2 methods (defecography, 80 patients; echodefecography, 76 patients; κ = 0.61; 95% CI = 0.48-0.73). The 2 techniques demonstrated identical findings in 6 patients without rectocele, and in 9 patients with grade I, 29 with grade II, and 19 patients with grade III rectoceles. Defecography identified rectal intussusception in 42 patients, with echodefecography identifying 37 of these cases, plus 4 additional cases, yielding substantial agreement (κ = 0.79; 95% CI = 0.57-1.0). Intussusception was associated with rectocele in 28 patients for both methods (κ = 0.62; 95% CI = 0.41-0.83). There was substantial agreement for anismus (κ = 0.61; 95% CI = 0.40-0.81) and for rectocele combined with anismus (κ = 0.61; 95% CI = 0.40-0.82). Agreement for grade III enterocele was classified as almost perfect (κ = 0.87; 95% CI = 0.66-1.0). LIMITATIONS: Echodefecography had limited use in identification of grade I and II enteroceles because of the type of probe used. CONCLUSIONS: Echodefecography may be used to assess patients with obstructed defecation, as it is able to detect the same anorectal dysfunctions found by defecography. It is minimally invasive and well tolerated, avoids exposure to radiation, and clearly demonstrates all the anatomic structures involved in defecation.

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