Publications by authors named "Carlos A Puig"

Background: While ample high-level evidence supports the limited use of antibiotics post-source control in intraabdominal infections, there is a paucity of available data in guiding antibiotic duration for intrathoracic infections. This study aims to analyze patient outcomes among those who have undergone surgical decortication for parapneumonic pleural empyema, comparing cases managed with infectious disease (ID) specialists against those without, and to identify predictive factors influencing antibiotic duration post-source control. We hypothesized that antibiotic duration would vary depending on the involvement of ID specialists.

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Article Synopsis
  • Research investigated the risks of morbidity and mortality in esophageal cancer patients who underwent emergency versus elective esophagectomy, using data from 2005 to 2020.
  • Among 10,067 patients, the emergency esophagectomy group had significantly higher rates of complications (65.2% vs. 44.2%) and 30-day mortality (6.1% vs. 2.8%), driven by factors like older age and higher ASA class.
  • Despite the increased complications, emergency procedures did not show a significant rise in short-term mortality rates, indicating that this data could inform future clinical decision-making.
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Background: Anastomotic leak is a major contributor to comorbidity and mortality following esophagectomy. We sought to assess rate and predictors of leak after esophagectomy and compare outcomes of chest versus neck anastomotic leaks.

Methods: A retrospective review was performed utilizing National-Surgical-Quality-Improvement-Program data from 2016-2019 for patients undergoing esophagectomy for malignancy.

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  • The study aimed to compare the use and outcomes of video-assisted (VATS) versus robotic-assisted (RATS) surgeries for lung cancer in the U.S. between 2015 and 2018.
  • A total of 83,105 patients were analyzed, with VATS being more common; however, RATS usage increased significantly over the study period.
  • Results showed that while RATS had a higher cost, complication rates and length of hospital stays were similar for both methods, with RATS showing a reduced risk for pneumonia.
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Primary pulmonary artery sarcomas are rare tumors and are commonly misdiagnosed as pulmonary embolism. Primary pulmonary sarcomas demonstrate intraluminal growth into the vessel, rather than through the wall; require complete resection to enhance survival; and require complex surgical planning. The purpose of this case report is to describe an optimal team approach with multidisciplinary planning facilitated by a customized 3-dimensional model to guide intervention and enhance communication.

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Minimally invasive esophagectomy is associated with an increased rate of paraconduit hernia. Recurrences after repair are typically adjacent to the gastroepiploic vessel passage through the hiatus. This technique provides a novel solution and approach to prevent recurrence or re-recurrence after repair by imbricating the blood supply to the conduit within the conduit, allowing circumferential fixation while protecting the conduit blood supply.

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Background: While emergent pancreatic resection for trauma has been previously described, no large contemporary investigations into the frequency, indications, and outcomes of emergent pancreatectomy (EP) secondary to complications of neoplastic disease exist. Modern perioperative outcomes data are currently unknown.

Methods: ACS-NSQIP was reviewed for all non-traumatic pancreatic resections (DP - distal pancreatectomy, PD - pancreaticoduodenectomy, or TP- total pancreatectomy) in patients with pancreatico-biliary or duodenal-ampullary neoplasms from 2005 to 2013.

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Background: The impact of additional resection for positive proximal bile duct margins during hepatic resection of hilar cholangiocarcinoma (HCCA) on survival and disease progression remains unclear. We asked how re-resection of positive proximal bile duct margins affected outcomes.

Methods: Patients undergoing resection between 1993-2017 were reviewed.

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This report describes the case of a 56-year-old woman with a 6-year history of severe epigastric pain after chest compressions for cardiac arrest. A comprehensive gastrointestinal workup was negative. However, an abdominal computed tomographic scan demonstrated an elongated xiphoid process.

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Background: Postoperative chylothorax can be managed by any or all of observation, parenteral nutrition, surgical duct ligation, pleurodesis, or thoracic duct embolization. The objective of this study was to determine the efficacy of standard therapies, such as surgical duct ligation and observation, compared with newer treatment methods (thoracic duct embolization).

Methods: A prospectively maintained database at a single institution was used to identify and review patients with postoperative chylothorax from 2008 to 2015.

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Background: Neoadjuvant chemotherapy (NAC) downstages tumor size and nodal disease. This study evaluates national practice patterns of NAC use in hormone receptor-negative breast cancer.

Methods: We identified patients in the National Cancer Data Base (NCDB) with hormone receptor-negative invasive breast cancer (2004-2012).

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Background: Patient triage in anatomically resectable, early stage pancreatic ductal adenocarcinoma (PDAC) with elevated carbohydrate antigen 19-9 (CA 19-9) remains unclear. We hypothesized that any CA 19-9 elevation indicates biologically borderline resectability.

Study Design: The National Cancer Data Base (NCDB 2010 to 2012) was reviewed for PDAC patients with reported CA 19-9.

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Background: The use of endoluminal stents has been proposed for the management of fistulas and anastomotic strictures after bariatric surgery. The objective of our study was to determine the success of endoscopically placed, self-expandable metal stents (SEMS) in bariatric patients specifically with either chronic persistent anastomotic or staple line leaks/fistulas or chronic, persistent anastomotic strictures.

Methods: We treated 21 patients including 5 with chronic staple line leaks/fistulas (4 from the gastric sleeve after biliopancreatic diversion with duodenal switch [BPD/DS] and 1 after removal of an eroding laparoscopic adjustable gastric band) and 16 with chronic anastomotic strictures (15 at the gastrojejunostomy after Roux-en-Y gastric bypass and 1 at the duodenoileal anastomosis after BPD/DS).

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Introduction: Internal hernias through the foramen of Winslow are rare events and constitute 8% of internal hernias but only 0.1% of all abdominal hernias.

Presentation Of Case: A 62-year-old man presented with upper abdominal pain, distention and vomiting, and was shown on CT scan to have the right colon and cecum herniating into the lesser sac through the foramen of Winslow.

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Liver transplant remains the ultimate treatment for decompensated liver disease. However, many diseases do recur after orthotopic liver transplant, which may affect recipients' quality of life and survival rate. We performed a systematic review of relevant epidemiological studies available on Medline that provided information on the recurrence of non-viral hepatitis after orthotopic liver transplantation in adult patients published until August 2010.

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