Techniques for bronchial anastomosis.
BACKGROUND
Many techniques have been described to optimize the construction of the bronchial anastomosis in lung transplantation. Over the past 60 months we have performed 86 bronchial anastomoses in 70 patients receiving single lung or bilateral single lung transplants.


METHODS
No anastomosis was wrapped and no attempt was made at revascularization of bronchial arteries. A continuous nonabsorbable suturing technique was used in all cases. Standard triple-drug immunotherapy with cyclosporine, azathioprine, and prednisone (starting at day 7) was used for each patient.


RESULTS
There were no anastomotic leaks, and seven stenoses were identified in five patients (7%). All complications were managed conservatively with stenting, and there were no related deaths. Mean time to stent placement was 109 days. One patient had bilateral stents placed prophylactically during an episode of severe infection for questionable anastomotic viability but without evidence of airway necrosis or obstruction. This patient died of infection at 16 days. Another patient died with stents in place at 71 days. In the four remaining patients, all stents have been removed after a mean of 310 days. These patients were followed up with serial bronchoscopy and were without evidence of recurrent obstruction at 2, 34, 35, and 36 months. Six of seven stenoses occurred in patients with cystic fibrosis. In each patient where stenosis developed the anastomosis was telescoped. Since abandoning the telescoping technique in the remaining 50 anastomoses (14 in patients with cystic fibrosis), no dehiscence or stenosis was encountered.


CONCLUSIONS
These data suggest that elaborate techniques aimed at construction of the bronchial anastomosis are not necessary. Moreover, attempts at telescoping may be detrimental. Patients with cystic fibrosis may be a population at higher risk for anastomotic complications. Airway complications can be managed conservatively with good results and little risk to the patient.
Anderson
M B
MB
Department of Surgery, University of California at San Diego 92103, USA.
Kriett
J M
JM
Harrell
J
J
Smith
C
C
Kapelanski
D P
DP
Tarazi
R Y
RY
Perricone
A
A
Jamieson
S W
SW
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D001980:Bronchi / Q000601:surgery*; D002423:Cause of Death; D003550:Cystic Fibrosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D013536:Suture Techniques; D016896:Treatment Outcome