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A prospective comparative study of the functional results associated with the use of Björk flap tracheostomy versus standard tracheostomy

Marini, Corrado P; McMurdo, Erin; McNelis, John; Lewis, Erin; Policastro, Anthony; Lombardo, Gary; Karev, Dmitry; Petrone, Patrizio
BACKGROUND:Placement of a tracheostomy for patients requiring prolonged mechanical ventilation (PMV) improves patients' comfort, decreases dead space ventilation, allows superior airway hygiene, and reduces the incidence of ventilator-associated pneumonia. Controversy still exists regarding the role of standard tracheostomy (ST) as opposed to the less frequently done Björk flap tracheostomy (BFT). This study compares the functional outcomes of these two techniques. STUDY DESIGN/METHODS:Seventy-nine patients receiving tracheostomy in a 12-month period: 38 BFT vs. 41 ST. Data included demographics, indications for PMV, ventilator days before tracheostomy, time to and a number of patients who passed the fiberoptic endoscopic evaluation of swallowing (FEES), time to and a number of patients decannulated. RESULTS:Indications in both groups were PMV from trauma (18/38 vs 15/41), pneumonia (13/38 vs 13/41), and ARDS (7/38 vs 11/4), respectively (p > 0.05). Patients in both groups did not differ with regard to age, sex, GCS, duration of PMV before tracheostomy, the time to and a number of patients who passed the 1st FEES. However, the number of days and the number of FEES required before the next successful FEES in the 20 BFT and 21 ST patients who failed the 1st was 9 (4) vs. 16 (5), and 2 (1) vs. 4 (1), respectively (p < 0.05). Additionally, the number of intraoperative complications in aggregate were 0/38 in the BFT as opposed to 6/41 in the ST group (p < 0.05). CONCLUSION/CONCLUSIONS:We conclude that BFT may be associated with an overall shorter time to restoration of normal swallowing when compared to ST.
PMID: 36648502
ISSN: 1863-9941
CID: 5419132

Long term outcomes of robotic-assisted abdominal wall reconstruction: a single surgeon experience

Halpern, D K; Liu, H; Amodu, L I; Weinman, K; Akerman, M; Petrone, P
INTRODUCTION/BACKGROUND:Robotic abdominal wall reconstruction (RAWR) is one of the most significant advances in the management of complex abdominal wall hernias. The objective of this study was to evaluate long term outcomes in a cohort of patients that underwent complex RAWR in a single center. METHODS:This was a longitudinal retrospective review of a cohort of 56 patients who underwent complex RAWR at least 24 months prior by a single surgeon at a tertiary care institution. All patients underwent bilateral retro-rectus release (rRRR) with or without robotic transversus abdominis release (rTAR). Data collected include demographics, hernia details, operative and technical details. The prospective analysis included a post-procedure visit of at least 24 months from the index procedure with a physical examination and quality of life survey using the Carolinas Comfort Scale (CCS). Patients with reported symptoms concerning for hernia recurrence underwent radiographic imaging. Descriptive statistics (mean ± standard deviation or median) were calculated for continuous variables. Chi-square or Fisher's exact test as deemed appropriate for categorical variables, and analysis of variance or the Kruskal-Wallis test for continuous data, were performed among the separate operative groups. A total score for the CCS was calculated and analyzed in accordance with the user guidelines. RESULTS:for rRRR. The mean length of follow-up was 28.1 months. Fifty-seven percent of patients underwent post-op imaging at an average follow-up of 23.5 months. Recurrence rate was 3.6% for all groups. There were no recurrences in patients that underwent solely bilateral rRRR. Two patients (7.7%) that underwent rTAR procedures were found with recurrence. Average time to recurrence was 23 months. Quality of life survey demonstrated an overall CCS score of 6.63 ± 13.95 at 24 months with 12 (21.4%) patients reporting mesh sensation, 20 (35.7%) reporting pain, and 13 (23.2%) reporting movement limitation. CONCLUSION/CONCLUSIONS:Our study contributes to the paucity of literature describing long term outcomes of RAWR. Robotic techniques offer durable repairs with acceptable quality of life metrics.
PMID: 36977947
ISSN: 1248-9204
CID: 5463192

Robotic-assisted completion cholecystectomy with repair of cholecystoduodenal fistula [Case Report]

Hurwitz, Joshua C; Kolwitz, Christine E; Kim, David Y; Petrone, Patrizio; Halpern, David K
Post-cholecystectomy syndrome (PCS) is a well-documented complication of incomplete cholecystectomy. The etiology is often post-surgical chronic inflammation from unresolved cholelithiasis, which is secondary to anatomical abnormalities, including a retained gallbladder or a large cystic duct remnant (CDR). An exceedingly rare consequence is retained gallstone fistulization into the gastrointestinal tract. We present a case of a 70-year-old female with multiple comorbidities 4 years status-post incomplete cholecystectomy, who developed PCS with cholecystoduodenal fistula secondary to retained gallstone in the remnant gallbladder, with CDR involvement, treated via robotic-assisted surgery. Reoperation in PCS has been traditionally performed via laparoscopic approach with recent advances made in robotic-assisted surgery. However, we report the first documented case of PCS complicated by bilioenteric fistula repaired with robotic-assisted surgery. This highlights the value of robotic-assisted surgery in complicated cases, where one must contend with post-surgical anatomic abnormalities and visualization difficulties. Subsequent investigation is necessary to objectively quantify the safety and reproducibility of our approach.
PMID: 37201105
ISSN: 2042-8812
CID: 5544312

Kwashiorkor after gastric bypass

Howell, R S; Shah, S; Khan, S; Brathwaite, C E M; Petrone, P; Levine, J
Gastric bypass has grown in popularity in recent years due to its high efficacy in achieving long-term weight loss in patients with morbid obesity. Gastric bypass has been described to further exacerbate baseline nutritional deficiencies due to reduced gastric capacity and malabsorption. In rare cases, when protein deficiency is severe, Kwashiorkor disease may arise. The incidence of Kwashiorkor specifically following gastric bypass is rare, with an incidence of 4.7%. We report a case of a female patient who underwent a gastric bypass and subsequently developed Kwashiorkor. Physicians' suspicion of index for Kwashiorkor should be high for patients presenting with signs or symptoms of severe malnutrition following weight-loss procedures.
ISSN: 2042-8812
CID: 5514572

Arcuate line hernia: a case report

Cohen, K; Kolwitz, C; Petrone, P; Halpern, D
Arcuate line hernias are a rare type of hernia with limited publications regarding their successful repair. The arcuate line is the inferior limit of the posterior leaf of the rectus sheath. An arcuate line hernia is a type of intraparietal hernia, meaning it is not a truly complete fascial defect of the abdominal and, therefore, may present with atypical symptoms. Although published data on arcuate line hernia repairs are limited to a handful of case reports and one literature review, reports regarding robotic repair are exceptionally rare. This case report is the second documented robotic approach to arcuate line hernias known to these authors.
ISSN: 2042-8812
CID: 5514672

Mature teratoma mimicking a mesothelial cyst of retroperitoneal origin Teratoma maduro que simula quiste mesotelial de origen retroperitoneal

Ceballos-Esparragón, José J.; Camarillo, Rolando M.; Cabrero-Acosta, Antonio; Petrone, Patrizio
ISSN: 2011-7582
CID: 5424402

Intestinal obstruction due to volvulus of the cecum in a patient with intestinal malrotation associated with situs ambiguous Obstrucción intestinal por vólvulo de ciego en paciente con malrotación intestinal asociado a situs ambiguous

Ceballos-Esparragón, José; Velaz-Pardo, Leyre; Martin-Camarillo, Rolando; Burbano, Fernando Cano; Petrone, Patrizio
Introduction. Complete or incomplete intestinal obstruction is one of the most frequent acute abdomen conditions. It constitutes between 20% and 35% of the urgent admissions of hospital surgical areas. Clinical case. We present a case of a patient with a history of prostate carcinoma, who began with clinical symptoms of intestinal obstruction and acute abdomen. He was diagnosed with volvulus of the cecum, intestinal malrotation, and situs ambiguous. Surgical treatment of the patient was successful. Conclusion. Knowledge of these pathological conditions is essential to be able to provide correct surgical treatment and reduce the mortality that these can lead to.
ISSN: 2011-7582
CID: 5424432

Crossing borders to change lives: Surgical mission amidst the COVID-19 pandemic

Hakmi, Hazim; Moreno, Johnny; Petrone, Patrizio; Sohail, Amir H; Burbano, Galo; Sbayi, Samer
INTRODUCTION/BACKGROUND:During the COVID pandemic, elective global surgical missions were temporarily halted for the safety of patients and travelling healthcare providers. We discuss our experience during our first surgical mission amidst the pandemic. We report a safe and successful treatment of the patients, detailing our precautionary steps and outcomes. METHODS:Retrospective manual chart review and data collection of patients' charts was conducted after IRB approval. We entail our experience and safety steps followed during screening, operating and postoperative care to minimize exposure and improve outcomes during a surgical mission in an outpatient setting during the pandemic. The surgical mission was from February 8 to February 12, 2022. RESULTS:A total of 60 patients who were screened. 33 patients underwent surgical intervention. One patient required postoperative hospitalization for a biliary duct leak. No patient or healthcare provider tested positive for COVID at the end of the mission. The average age of patients was 46.9 years. The average operative time was 116 min, and all patients had local nerve blocks. It included 45 health work providers. CONCLUSIONS:It is safe to perform outpatient international surgery during the pandemic while following pre-selected precautions.
PMID: 36410642
ISSN: 2173-5077
CID: 5384112

Retrospective observational study correlating traumatic pelvic fractures and their associated injuries according to the Tile classification

Morales-García, Dieter; Pérez-Nuñez, María Isabel; Portilla-Mediavilla, Leire; Ovejero-Gómez, Víctor Jacinto; Marini, Corrado P; Petrone, Patrizio
INTRODUCTION/BACKGROUND:Pelvic fractures due to high energy trauma present a high risk of associated injuries that compromise the functional and vital prognosis of the patients. The objective of this study was to analyze the relationship between traumatic pelvic fractures and their associated injuries according to the Tile classification. METHODS:Retrospective observational study of patients who suffered traumatic pelvic fractures (Type A, B or C of the Tile classification) with concomitant associated injuries, analyzing hemoglobin levels, between 6/2013 and 1/2016. RESULTS:A total of 42 patients were included; of those 69% (n = 29) were males, mean age was 48 years. 45% (n = 19) suffered traffic accidents and 26.2% (n = 11) falls. There was a different proportion in pelvic injuries: Tile A (n = 15, 35.7%), B (n = 20, 47.6%), and C (n = 7, 16.6%) of cases. 54.8% (n = 23) underwent surgery, 21.4% (n = 9) needed temporary or definitive external fixation. Significant differences were found between Tile A type and scapula fractures (P = .032), and Tile B with sacral fractures (P = .033) and visceral injuries (P = .049), while there is a tendency without a statistical significal between Tile C and costal fractures. 61.9% (n = 26) needed blood transfusion; 9.5% (n = 4) presented hypovolemic shock. CONCLUSIONS:Tile A pelvic fractures were associated with scapular fractures, and Tile B with transforaminal fractures of the sacrum and with visceral injuries (lungs, liver and genitourinary). The small number of Tile C prevent us to confirm an association with any pathology, although they are the ones which presnt more hemodynamically instability and thoracic injuries.
PMID: 36265775
ISSN: 2173-5077
CID: 5360522

The First COVID-19 Pandemic Wave and the Effect on Health Care Trainees: A National Survey Study

Liu, Helen H; Petrone, Patrizio; Akerman, Meredith; Howell, Raelina S; Morel, Andrew H; Sohail, Amir H; Alsamarraie, Cindy; Brathwaite, Barbara; Kinzler, Wendy; Maurer, James; Brathwaite, Collin E M
BACKGROUND:This study observes the trends and patterns among trainees during the coronavirus disease 2019 (COVID-19) pandemic and their response to resident education and hospital/program support. METHODS:An anonymous online 31-question survey was distributed to medical students and postgraduate year residents. Topics included were demographics, clinical responsibilities, educational/curricula changes, and trainee wellness. Descriptive analysis was performed for each set of demographic groupings as well as 2 and 3 group comparisons. RESULTS:< .0001). CONCLUSION/CONCLUSIONS:We aim to provide continued educational support for our trainees' clinical development and well-being during the COVID-19 pandemic.
PMID: 36121024
ISSN: 1555-9823
CID: 5333002