Bio

Clinical Focus


  • Pediatric Surgery

Academic Appointments


Administrative Appointments


  • Director Hispanic Center for Pediatric Surgery, Lucile Packard Children's Hospital (2011 - Present)
  • Director Minimal Access Pediatric Surgery, Lucile Packard Children's Hospital-Stanford University (2011 - Present)
  • Director Outpatient Pediatric Surgery Clinics, Lucile Packard Children's Hospital (2011 - Present)
  • Site Director Pediatric Surgery Rotation-General Sugery Residents and Medical Students, Lucile Packard Children's Hospital-Stanford University (2011 - Present)
  • Medical Director Vascular Access program, Lucile Packard Children's Hospital-Stanford University (2011 - Present)

Honors & Awards


  • Alpha Omega Alpha, AOA (2007-present)
  • Ramsay Family endowed Fellow in Pediatric Surgery, Lucile Packard Children's Hospital-Stanford University (2009-2011)
  • Hispanic Center of Excellence Fellow, Hispanic Center of Excellence-Stanford University (2011-2012)

Professional Education


  • Board Certification: Pediatric Surgery, American Board of Surgery (2012)
  • Residency, University of Nebraska Medical Center, General Surgery (2009)
  • Fellowship:Stanford Hospital and Clinics - Pediatric Surgery (2011) CA
  • Board Certification: General Surgery, American Board of Surgery (2009)
  • Internship:University of Nebraska Medical Center (2009) NE
  • Residency:British Hospital of Buenos Aires (2005)
  • Medical Education:University of Buenos Aires (2001)

Community and International Work


  • Hispanic Center for Pediatric Surgery, Stanford University

    Topic

    Clinical Outcomes-Quality Improvement

    Populations Served

    Hispanic population

    Location

    Bay Area

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


Minimal Access Surgery
Neonatal Surgery
Sutured vs Sutureless Gastroschisis Closure
Ultrasound vs anatomic landmark central line placement
Hispanic Center for Pediatric Surgery

Clinical Trials


  • Sutureless vs Sutured Gastroschisis Closure Recruiting

    This study aims to prospectively assess outcomes of sutureless versus sutured gastroschisis closure with a randomized control trial. The parameters of this trial were determined using our retrospective study as pilot data. Primary outcome measures will be time on ventilator and time to initiating enteral feeds. Other outcome measures will include cosmetic outcome, length of hospital stay and the associated rate of complications, including bowel resection, sepsis, and death.

    View full details

Teaching

2013-14 Courses


Publications

Journal Articles


  • Less invasive pedicled omental-cranial transposition in pediatric patients with moyamoya disease and failed prior revascularization. Neurosurgery Navarro, R., Chao, K., Gooderham, P. A., Bruzoni, M., Dutta, S., Steinberg, G. K. 2014; 10: 1-14

    Abstract

    Patients with moyamoya disease and progressive neurologic deterioration despite previous revascularization pose a major treatment challenge. Many have exhausted typical sources for bypass or have ischemia in areas that are difficult to reach with an indirect pedicled flap. Omental-cranial transposition has been an effective, but sparingly used technique because of its associated morbidity.We have refined a laparoscopic method of harvesting an omental flap that preserves its gastroepiploic arterial supply.The pedicled omentum can be lengthened as needed by dividing it between the vascular arcades. It is transposed to the brain via skip incisions. The flap can be trimmed or stretched to cover ischemic areas of the brain. The cranial exposure is performed in parallel with pediatric surgeons. We performed this technique in 3 pediatric moyamoya patients (aged 5 to 12 years) with prior STA-MCA bypasses and progressive ischemic symptoms. In 1 patient, we transposed omentum to both hemispheres.Blood loss ranged from 75 to 250 ml. After surgery, patients immediately tolerated a diet and were discharged in 3 to 5 days. All 3 children's ischemic symptoms resolved within 3 months postoperatively. MRI at 1 year showed improved perfusion and no new infarcts. Angiography showed excellent revascularization of targeted areas and patency of the donor gastroepiploic artery.Laparoscopic omental harvest for cranial-omental transposition can be performed efficiently and safely. Moyamoya patients appear to tolerate this technique much better than laparotomy. With this method we can achieve excellent angiographic revascularization and resolution of ischemic symptoms.

    View details for DOI 10.1227/NEU.0000000000000119

    View details for PubMedID 23921707

  • A Prospective Randomized Trial of Ultrasound- vs Landmark-Guided Central Venous Access in the Pediatric Population. Journal of the American College of Surgeons Bruzoni, M., Slater, B. J., Wall, J., St Peter, S. D., Dutta, S. 2013; 216 (5): 939-943

    Abstract

    The purpose of this prospective randomized study was to compare landmark- to ultrasound-guided central venous access when performed by pediatric surgeons. The American College of Surgeons advocates for use of ultrasound in central venous catheter placement; however, this is not universally embraced by pediatric surgeons. Complication risk correlates positively with number of venous cannulation attempts.With IRB approval, a randomized prospective study of children under 18 years of age undergoing tunneled central venous catheter placement was performed. Patient accrual was based on power analysis. Exclusion criteria included known nonpatency of a central vein or coagulopathy. After randomization, the patients were assigned to either ultrasound-guided internal jugular vein access or landmark-guided subclavian/internal jugular vein access. The primary outcomes measure was number of attempts at venous cannulation. Secondary outcomes measures included: access times, number of arterial punctures, and other complications. Continuous variables were compared using 2-tailed Student's t-test. Discrete variables were analyzed with chi-square. Significance was defined as p < 0.05.There were 150 patients enrolled between April 2008 and September 2011. There was no difference when comparing demographic data. Success at first attempt was achieved in 65% of patients in the ultrasound group vs 45% in the landmark group (p = 0.021). Success within 3 attempts was achieved in 95% of ultrasound group vs 74% of landmark group (p = 0.0001).Ultrasound reduced the number of cannulation attempts necessary for venous access. This indicates a potential to reduce complications when ultrasound is used by pediatric surgeons.

    View details for DOI 10.1016/j.jamcollsurg.2013.01.054

    View details for PubMedID 23478546

  • Complete resection of a rare intrahepatic variant of a choledochal cyst JOURNAL OF PEDIATRIC SURGERY Salles, A., Kastenberg, Z. J., Wall, J. K., Visser, B. C., Bruzoni, M. 2013; 48 (3): 652-654

    Abstract

    The vast majority of choledochal cysts occur as either saccular or diffuse fusiform dilatation of the extrahepatic bile duct. We describe the complete resection of a rare single intrahepatic choledochal cyst communicating with the extrahepatic biliary tree. While previous reports describe partial resection with enteral drainage, we performed a complete resection of this rare choledochal cyst.

    View details for DOI 10.1016/j.jpedsurg.2012.12.016

    View details for Web of Science ID 000316470100037

    View details for PubMedID 23480926

  • Chest wall reconstruction using implantable cross-linked porcine dermal collagen matrix (Permacol) JOURNAL OF PEDIATRIC SURGERY Lin, S. R., Kastenberg, Z. J., Bruzoni, M., Albanese, C. T., Dutta, S. 2012; 47 (7): 1472-1475

    Abstract

    Chest wall reconstruction in children is typically accomplished with either primary tissue repair or synthetic mesh prostheses. Primary tissue repair has been associated with high rates of scoliosis, whereas synthetic prostheses necessitate the placement of a permanent foreign body in growing children. This report describes the use of biologic mesh (Permacol; Covidien, Mansfield, MA) as an alternative to both tissue repair and synthetic prostheses in pediatric chest wall reconstruction.A retrospective chart review was performed identifying patients undergoing chest wall reconstruction with biologic mesh at our tertiary referral children's hospital between 2007 and 2011. Data collection included patient demographics, indication for chest wall resection, number of ribs resected, the administration of postoperative radiation, length of follow-up, postoperative complications, and the degree of spinal angulation (preoperatively and at most recent follow-up).Five patients (age, 9.0-21.7 years; mean, 15.4 years) underwent resection for primary chest wall malignancy followed by reconstruction with biologic mesh (Permacol) during the study period. There were no postoperative mesh-related complications, and none of the patients developed clinically significant scoliosis (follow-up, 1.1-2.6 years; mean 1.9 years).Biologic mesh offers a safe and dependable alternative to both primary tissue repair and synthetic mesh in pediatric patients undergoing chest wall reconstruction.

    View details for DOI 10.1016/j.jpedsurg.2012.05.002

    View details for Web of Science ID 000306523300039

    View details for PubMedID 22813819

  • Single-site umbilical laparoscopic splenectomy SEMINARS IN PEDIATRIC SURGERY Bruzoni, M., Dutta, S. 2011; 20 (4): 212-218

    Abstract

    Laparoscopic splenectomy was first described in children in 1993. Since then, it has become a commonly performed procedure in children because of reduced discomfort and hospitalization and significantly improved cosmesis compared with the open approach. With the advent of single-site laparoscopic surgery, it is only natural that this approach be used for splenectomy. This article will describe the reasons that the single-site approach might be useful for splenectomy and also the technique used at the author's institution. Moreover, a brief review of the current literature in children will be presented.

    View details for DOI 10.1053/j.sempedsurg.2011.05.005

    View details for Web of Science ID 000296043500006

    View details for PubMedID 21968157

  • A modification of the laparoscopic transcutaneous inguinal hernia repair to achieve transfixation ligature of the hernia sac JOURNAL OF PEDIATRIC SURGERY Kastenberg, Z., Bruzoni, M., Dutta, S. 2011; 46 (8): 1658-1664

    Abstract

    The proposed benefits of laparoscopic inguinal hernia repair in the pediatric population include less postoperative pain, smaller scars, and easier access to the contralateral groin. This is countered by slightly higher recurrence rates reported in some series. These differences are attributable to variation in the laparoscopic technique, surgeon experience, and certain anatomic features. We describe a modification of the laparoscopic-assisted transcutaneous hernia repair that achieves transfixation ligature of the hernia sac and that may further reduce recurrence.Institutional review board approval was obtained, and a retrospective chart review of all patients undergoing repair of symptomatic hernias using this new technique was carried out. Data collection included demographics, laterality of hernia, operative time, recurrence rate, and complications.Twenty-one patients (age 1-144 months) underwent hernia repair between October 2009 and October 2010 using a novel technique of transcutaneous transfixation ligature of the neck of the hernia sac. The mean operative time was 18 minutes (8-35 minutes). Follow-up was from 1 to 12 months. There was no intraoperative or postoperative complication and no recurrences to date.The technique described is a modification of the existing laparoscopic-assisted transcutaneous inguinal hernia repair that more closely approximates the criterion standard open repair. The technique addresses some prevailing concerns with the initially described method of transcutaneous repair, and short-term outcomes are positive. Long-term outcomes remain to be defined.

    View details for DOI 10.1016/j.jpedsurg.2011.03.022

    View details for Web of Science ID 000293950100040

    View details for PubMedID 21843740

  • Management of the primary tumor in patients with metastatic pancreatic neuroendocrine tumor: a contemporary single-institution review AMERICAN JOURNAL OF SURGERY Bruzoni, M., Parikh, P., Celis, R., Are, C., Ly, Q. P., Meza, J. L., Sasson, A. R. 2009; 197 (3): 376-380

    Abstract

    Pancreatic nonfunctioning neuroendocrine tumors (PNFNETs) are an uncommon malignancy and often present with metastatic disease. There is a lack of information on the management of the primary tumor in patients who present with unresectable synchronous hepatic metastases.A retrospective review (2001-2008) of PNFNETs was conducted. Patients were divided into 3 groups: PNFNET without evidence of hepatic metastasis (group A), PNFNET with metastatic disease involving less than 50% of the liver (group B), and PNFNET with metastatic disease involving more than 50% of the liver (group C). Clinical data and outcomes were analyzed.Thirty-five patients with PNFNET were identified (group A = 15, group B = 11, group C = 9). Resection of the pancreatic tumor was performed in 26 patients. With a mean follow-up period of 30 months, death from disease progression occurred in 1 patient in group A, none in group B, and in 7 in group C.In selected patients, resection of the primary pancreatic tumor even in the setting of unresectable but limited hepatic metastases may be indicated.

    View details for DOI 10.1016/j.amjsurg.2008.11.005

    View details for Web of Science ID 000264277400037

    View details for PubMedID 19245918

  • Comparison of short bowel syndrome acquired early in life and during adolescence TRANSPLANTATION Bruzoni, M., Sudan, D. L., Cusick, R. A., Thompson, J. S. 2008; 86 (1): 63-66

    Abstract

    Prolonged survival in pediatric patients with short bowel syndrome (SBS) is now possible because of parenteral nutrition and small bowel transplantation. We hypothesized that there may be important differences between adult patients who developed SBS during early childhood and those who develop this as adolescents.Sixty-seven patients between the ages of 16 and 40 years were studied. Thirty patients developing SBS younger than 12 years comprised the pediatric group (PG), 37 developing SBS at age 13 to 25 constituted the adolescent group (AG).Midgut volvulus (n=11) was the most common cause in the PG followed by gastroschisis (n=5), intestinal atresia (n=5), and necrotizing enterocolitis (n=4). The most common cause of SBS in the AG was trauma (n=13), followed by tumors (n=7) and postoperative complications (n=5). A similar portion in each group had intestinal remnants less than 60 cm (69% vs. 58%), however, the PG was more likely to have a colon remnant (97% vs. 71%, P<0.05), and less likely to have an ostomy (7% vs. 47%, P<0.05). Patients in PG were followed significantly longer than AG (246+/-67 vs. 90+/-58 months, P<0.05). A similar portion of the patients require long-term parenteral nutrition (86% vs. 84%) or have undergone intestinal transplant (28% vs. 23%). Significantly more pediatric patients had negative height z scores when compared with the adolescents.Acknowledging the inherent biases created in defining the two groups, pediatric patients developing SBS early in life seem to be similar to those who develop SBS as adolescents with regards to long-term outcome, despite differences in origin and intestinal anatomy.

    View details for DOI 10.1097/TP.0b013e3181734995

    View details for Web of Science ID 000257790400012

    View details for PubMedID 18622279

  • Open and laparoscopic spleen-preserving, splenic vessel-preserving distal pancreatectomy: Indications and outcomes JOURNAL OF GASTROINTESTINAL SURGERY Bruzoni, M., Sasson, A. R. 2008; 12 (7): 1202-1206

    Abstract

    Spleen-preserving distal pancreatectomy has been described lately in order to reduce the risks associated with splenectomy. The aim of this study is to report a series of open and laparoscopic distal pancreatectomies with splenic vessel preservation.From June 2001 to April 2007, 11 spleen-preserving distal pancreatectomies were performed, utilizing open and laparoscopic techniques. The main variables recorded were demographics, intra- and postoperative complications, and final pathology results.All 11 spleen-preserving distal pancreatectomies were performed successfully. Laparoscopic resection was possible in seven patients. Postoperative morbidity consisted of one pancreatic fluid collection. The overall incidence of pancreatic leak was 18%. The final pathology revealed serous cystadenoma in 36% of the cases, neuroendocrine tumor in two cases, three mucinous cystadenomas, one carcinoid tumor, and one intrapancreatic spleen. With a median follow-up of 26 months, no splenic vein thrombosis was detected.Open or laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation is a feasible and safe procedure. In selected cases of cystic lesions and low grade neoplasms, distal pancreatectomy with splenic preservation is possible.

    View details for DOI 10.1007/s11605-008-0512-0

    View details for Web of Science ID 000257206100011

    View details for PubMedID 18437500

  • Pancreatic incidentalomas: clinical and pathologic spectrum AMERICAN JOURNAL OF SURGERY Bruzoni, M., Johnston, E., Sasson, A. R. 2008; 195 (3): 329-332

    Abstract

    Incidental abnormalities are increasingly being detected. The pathology and clinical outcome of patients with pancreatic incidentalomas have not been well characterized.We reviewed the records of 356 patients with pancreatic abnormalities from August 2001 to June 2007. Clinical and pathologic data were collected for a cohort of patients who had incidental pancreatic lesions detected by imaging modalities.Fifty-seven pancreatic incidentalomas were identified. Ninety percent of them were detected by computed axial tomography (CT). The most frequent indications for imaging were genitourinary symptoms and cancer surveillance. Sixty percent of the lesions were solid, and 40% were cystic. Surgical resection was performed in 33 patients. Locally advanced disease was found in six patients, and metastatic disease was found in 9 patients. The most frequent diagnoses were ductal adenocarcinoma, neuroendocrine tumors, and serous cystadenoma.Patients with pancreatic incidentalomas account for a significant patient subgroup. Incidental pancreatic lesions occur frequently and require prompt surgical evaluation.

    View details for DOI 10.1016/j.amjsurg.2007.12.027

    View details for Web of Science ID 000253847600017

    View details for PubMedID 18308040

  • Low doses of pamidronate to treat osteopenia in children with severe cerebral palsy: a pilot study DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Plotkin, H., Coughlin, S., Kreikemeier, R., Heldt, K., Bruzoni, M., Lerner, G. 2006; 48 (9): 709-712

    Abstract

    The aim of this study was to test the efficacy of low doses of pamidronate in increasing bone mineral density (BMD) in non-ambulatory children and adolescents with cerebral palsy (CP). Twenty-three non-ambulatory children and adolescents (12 females, 11 males; mean age 10y [SD 5y], range 4y 1 mo-17 y 11 mo) with severe spastic quadriplegic CP and low BMD were recruited from a multidisciplinary clinic. Severity of CP was graded at Level IV (n=10) and Level V (n=13) using the Gross Motor Function Classification System. Patients received intravenous pamidronate (4.12 mg/kg/y, maximum 45 mg/d) every 4 months. Lumbar spine and femoral neck BMD were measured at baseline and after 4 and 12 months. Twelve months after the first dose of pamidronate there was a significant increase in lumbar spine and femoral neck BMD (p<0.01 for both sites) and z scores compared with baseline values (p<0.01 for both sites). Mean BMD z scores increased 1.6 points for femoral neck and 1.9 points for lumbar spine after 12 months of pamidronate treatment. Serum intact parathyroid hormone increased significantly and cross-linked N-teleopeptide of type I collagen decreased significantly at 12 months. No significant side effect was noted. Low doses of pamidronate are well tolerated and significantly increase BMD in non-ambulatory children and adolescents with CP.

    View details for DOI 10.1017/S0012162206001526

    View details for Web of Science ID 000240173500003

    View details for PubMedID 16904014

  • Transcervical carotid stenting with flow reversal for neuroprotection: Technique, results, advantages, and limitations VASCULAR Pipinos, I. I., Bruzoni, M., Johanning, J. M., Longo, G. M., Lynch, T. G. 2006; 14 (5): 245-255

    Abstract

    Carotid angioplasty and stenting are progressively earning a role as a less invasive alternative in the treatment of carotid occlusive disease. The most common approach for carotid artery stenting involves transfemoral access and use of a filter or balloon device for neuroprotection. This approach has limitations related to both the site of access and the method of neuroprotection. Specifically, an aortoiliac segment with advanced occlusive or aneurysmal disease or an anatomically unfavorable or atheromatous arch and arch branches can significantly limit the safety of the retrograde transfemoral pathway to the carotid bifurcation. Additionally, data provided by the use of transcranial Doppler monitoring and diffusion-weighted magnetic resonance imaging in patients undergoing filter- or balloon-protected carotid artery stenting demonstrate that currently available devices are associated with a considerable incidence of cerebral embolization. To address these limitations, we, along with others, have employed a direct transcervical approach for carotid artery stenting that incorporates the principle of flow reversal for neuroprotection. The technique bypasses all of the anatomic limitations of transfemoral access and simplifies the application of flow reversal, which is one of the safest neuroprotection techniques. The purpose of this review is to describe our method of transcervical carotid artery stenting, review the accumulating outcomes data, and discuss the clinical advantages of and indications for this increasingly popular technique.

    View details for DOI 10.2310/6670.2006.00050

    View details for Web of Science ID 000202989800002

    View details for PubMedID 17038294

  • Hemorrhagic adrenal pseudocyst: laparoscopic treatment SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Amarillo, H. A., Bruzoni, M., Loto, M., Castagneto, G. H., Mihura, M. E. 2004; 18 (10)

    Abstract

    The incidence of adrenal hemorrhagic pseudocyst is very low. A total of 613 adrenal cysts and 85 hemorrhagic pseudocysts have been reported. A laparoscopically diagnosed and resolved case is presented here, together with the current diagnostic and therapeutic procedures.A 40-year-old woman was admitted because of an asymptomatic nonfunctional right adrenal tumor. Right laparoscopic adrenalectomy was performed, 8-cm cyst which found an with thick walls and organized hematic content. The postoperative course was uneventful. Follow-up was 14 months. The pathology was an adrenal hemorrhagic pseudocyst.A total of 56% of adrenal cysts are pseudocysts. One third of them have hematic content. They may present as an asymptomatic finding with nonspecific symptoms or as a hormone secreting or complicated tumor. Their vascular etiology is not yet totally accepted. There is a tendency for intracystic bleeding. it is advisable to evaluate the hormonal profile and morphologic characteristics in all cases. Treatment options include needle aspiration, percutaneous drainage, and cyst or gland resection. Laparoscopic excision should be evaluated.

    View details for DOI 10.1007/s00464-003-4547-8

    View details for Web of Science ID 000224475100029

    View details for PubMedID 15791385

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