Publications by authors named "Richard Billingham"

Background: Randomized controlled trials demonstrate the efficacy of arginine-enriched nutritional supplements (immunonutrition) in reducing complications after surgery. The effectiveness of preoperative immunonutrition has not been evaluated in a community setting.

Objective: This study aims to determine whether immunonutrition before elective colorectal surgery improves outcomes in the community at large.

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Background: Randomized trials have found that alvimopan hastens return of bowel function and reduces length of stay (LOS) by 1 day among patients undergoing colorectal surgery. However, its effectiveness in routine clinical practice and its impact on hospital costs remain uncertain.

Study Design: We performed a retrospective cohort study of patients undergoing elective colorectal surgery in Washington state (2009 to 2013) using data from a clinical registry (Surgical Care and Outcomes Assessment Program) linked to a statewide hospital discharge database (Comprehensive Hospital Abstract Reporting System).

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Article Synopsis
  • The incidence of anal intraepithelial neoplasia is rising, particularly among high-risk groups like MSM (men who have sex with men), HIV-positive individuals, and the immunosuppressed.
  • The progression to invasive anal cancer from high-grade lesions is about 5%, but higher for high-risk patients, and while anal cytology is used for screening, it doesn’t reliably connect to actual disease presence.
  • Treatment options range from nonoperative methods like topical medications to surgical procedures, but there are still high recurrence rates, emphasizing the need for vigilant surveillance, with no established optimal follow-up guidelines.
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Objective: To determine the impact of elective colectomy on emergency diverticulitis surgery at the population level.

Background: Current recommendations suggest avoiding elective colon resection for uncomplicated diverticulitis because of uncertain effectiveness at reducing recurrence and emergency surgery. The influence of these recommendations on use of elective colectomy or rates of emergency surgery remains undetermined.

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Importance: Venous thromboembolism (VTE) is an important complication of colorectal surgery, but its incidence is unclear in the era of VTE prophylaxis.

Objective: To describe the incidence of and risk factors associated with thromboembolic complications and contemporary VTE prophylaxis patterns following colorectal surgery.

Design, Setting, And Participants: Prospective data from the Washington State Surgical Care and Outcomes Assessment Program (SCOAP) linked to a statewide hospital discharge database.

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Objective: To assess the reported indications for elective colon resection for diverticulitis and concordance with professional guidelines.

Background: Despite modern professional guidelines recommending delay in elective colon resection beyond 2 episodes of uncomplicated diverticulitis, the incidence of elective colectomy has increased dramatically in the last 2 decades. Whether surgeons have changed their threshold for recommending a surgical intervention is unknown.

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Purpose: Management of rectal bleeding in patients with radiation proctitis presents a conundrum for practitioners. Surgeons are appropriately concerned about using conventional methods of treatment in these patients, such as cautery for bleeding areas in the rectum, rubber band ligation, or excision of internal and/or external hemorrhoids, for fear of poor healing and possible exacerbation of the original problem. Few randomized controlled trials are available on the treatment of radiation proctitis alone, and no literature exists pertaining to the management of symptomatic hemorrhoids in the radiated patient.

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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 composite of adverse events (ie, death or clinical reintervention) for patients undergoing elective colorectal surgery at 48 hospitals from the 4th quarter of 2005 through 4th quarter of 2010.

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Objective: To evaluate the effect of routine anastomotic leak testing (performed to screen for leaks) vs selective testing (performed to evaluate for a suspected leak in a higher-risk or technically difficult anastomosis) on outcomes in colorectal surgery because the value of provocative testing of colorectal anastomoses as a quality improvement metric has yet to be determined.

Design: Observational, prospectively designed cohort study.

Setting: Data from Washington state's Surgical Care and Outcomes Assessment Program (SCOAP).

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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 to gather evidence in order to support data-driven protocol development, an e-mail survey was sent to the membership of the American Society of Colorectal Surgeons to assess current attitudes and practices pertaining to prevention and management of wound infections.

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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 the clinical management of pruritus ani.

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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 programs to decrease hospital stay. This survey investigated clinical practice around colonic operations across Europe and the United States.

Methods: The survey was conducted in 295 hospitals in the United Kingdom, France, Germany, Italy, Spain, and the United States.

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In the few days following major surgical procedures, there are three main physiologic processes which are amenable to surgical management: restoration of fluid and electrolyte homeostasis, management of pain, and attention to gastrointestinal function. New information regarding optimizing the management of these processes is presented, which may accelerate recovery and give improved comfort following abdominal surgery. The type of incision used seems not to be a major factor in such recovery.

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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.

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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 elective colon and rectal resections, and then determine whether this led to any improvement in measurable outcomes.

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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 eight treatment regimens (0.

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