Richard P Billingham

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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)
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)
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)
Thirty-eight patients with condylomata acuminata of the anus, requiring surgical therapy, had the left half of the anus treated with conventional electrical cautery, while the right half of the anus was treated with the carbon dioxide laser at the same time. Patients were questioned about the amount of pain on both sides and were studied for evidence of(More)
BACKGROUND 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. MATERIALS AND METHODS In order to assess current attitudes and practices about this subject, and as a guide to designing a randomized trial(More)
BACKGROUND The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large. STUDY DESIGN The Surgical Care and Outcomes Assessment Program (SCOAP) is a quality improvement benchmarking initiative in the Northwest using medical record-based data. We evaluated the use of laparoscopy and a(More)
Pruritus ani is a dermatologic condition characterized by an unpleasant itching or burning sensation in the perianal region. This article briefly discusses the incidence and classification of pruritus ani followed by a more lengthy discussion of primary and secondary pruritus ani. The important points are summarized and a simple algorithm is provided for(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)
Acute massive hematochezia provides one of the greatest diagnostic and therapeutic challenges to the physician. Although most patients stop bleeding spontaneously and further evaluation can be carried on with less urgency, 10% to 15% require urgent diagnostic and therapeutic procedures. Clearly, the least invasive effective solution to the bleeding problem(More)