Richard P. Billingham

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BACKGROUND Despite clinical evidence showing that steps can be taken perioperatively to enhance postoperative recovery and decrease morbidity in colonic operation patients, there is no comprehensive information on how widespread such practices are, or the combination of such steps into effective multimodal rehabilitation (fast-track) colonic surgery(More)
Tremendous variation in patient care exists, both among medical centers and among individual surgeons, in the field of colon and rectal surgery. Clinical or critical pathways based on “best demonstrated practices” from the medical literature have led to improved outcomes for many disease entities. The objective of this study was to develop a pathway for(More)
PURPOSE Rectal prolapse typically occurs in elderly patients, who are often poor surgical candidates because of the presence of multiple comorbidities. Abdominal approaches to procidentia have low recurrence rates but are associated with higher rates of morbidity and mortality. Perineal rectosigmoidectomy (Altemeier repair) is a safe and effective approach(More)
ne of the things that distinguishes surgeons who are comfortable and ompetent in the management of anorectal disease from others is their pproach to the patient. Such an approach ideally should put the patient at ase and reduce the fear and embarrassment that are often associated, in the atient’s mind, with seeking care for anorectal problems. The process(More)
PURPOSE The aim of this study was to determine the optimal dose and dosing interval of nitroglycerin ointment to heal chronic anal fissures. METHOD A randomized, double-blind study of intra-anally applied nitroglycerin ointment (Anogesic) was conducted in 17 centers in 304 patients with chronic anal fissures. The patients were randomly assigned to one of(More)
of Colorectal Surgery, Vice-Chair, Department of Surgery, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio. Henrik Kehlet, MD, PhD, Professor, Section for Surgical Pathophysiology, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark. Anthony J. Senagore, MD, Professor and Chair, Department of Surgery, Medical(More)
Postoperative wound infections are a widespread and costly problem, especially in colorectal surgery. Despite their prevalence, there are few data regarding appropriate management and prevention strategies. In order to assess current attitudes and practices about this subject, and as a guide to designing a randomized trial to gather evidence in order to(More)
PURPOSE Known late complications of ileal pouch-anal anastomoses include chronic pouchitis, poor pouch function, or stricture. These may jeopardize the pouch and may require pouch salvage procedures. Prolapse of the ileoanal pouch is a little-known complication infrequently noted in the literature. The objective of this study was to determine the prevalence(More)
Duodenal Crohn's disease is a rare condition not frequently encountered by the general or colo-rectal surgeon. Manifestations of Crohn's disease may appear in the duodenum as result of primary involvement, or secondary to complications of more distal gastrointestinal disease. Symptoms of duodenal Crohn's are often non-specific, and diagnosis can be(More)