title: Superiority of end-to-end versus telescoped bronchial anastomosis in single lung transplantation for pulmonary emphysema.
abstract: OBJECTIVE
  To assess the influence of surgical technique (telescoped versus end-to-end anastomosis) on the incidence of bronchial anastomotic complications in patients who underwent single lung transplantation for pulmonary emphysema.
  
  
  METHODS
  Seventy-six adult recipients of single lung transplants for pulmonary emphysema were evaluated for the presence of 3 types of major bronchial anastomotic complications: ischemia, dehiscence, and severe stenosis. Surgical technique, clinical course, and mortality were reviewed retrospectively.
  
  
  RESULTS
  The 3 major complications were observed in 11 (34%; ischemia), 8 (25%; dehiscence), and 11 (34%; severe stenosis) of 32 telescoped bronchial anastomoses. In contrast, ischemia, dehiscence, and severe stenosis occurred in only 4 (9%), 1 (2%), and 2 (5%) of 44 end-to-end anastomoses (P =.0087, P =.0034, and P =.0012, respectively). The relative risk of ischemia, dehiscence, and severe stenosis in telescoped anastomoses was 2.1, 2.5, and 2.5, respectively, compared with end-to-end anastomoses. Five (13%) telescoped anastomoses required stent placement as compared with only 2 (5%) end-to-end anastomoses (P =.1244). Early postoperative pneumonia was more common in the telescoped anastomosis group (56%) than in the end-to-end group (32%; P =.0380). There was a trend toward shorter survival in the telescoped anastomosis group (mean survival 1045 +/- 145 days) as compared with the end-to-end group (mean survival 1289 +/- 156 days), but these differences did not achieve statistical significance (P =.2410).
  
  
  CONCLUSIONS
  In patients who underwent single lung transplantation for pulmonary emphysema, telescoped anastomoses were associated with a higher incidence of bronchial anastomotic complications than end-to-end anastomoses.
authors.affiliation: Department of Surgery, Columbia University, College of Physicians & Surgeons, New York, NY 10032, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Garfein
authors.forename: M E
authors.initials: ME
authors.lastname: Ginsberg
authors.forename: L
authors.initials: L
authors.lastname: Gorenstein
authors.forename: C C
authors.initials: CC
authors.lastname: McGregor
authors.forename: L L
authors.initials: LL
authors.lastname: Schulman
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D001980:Bronchi / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D001999:Bronchoscopy; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011656:Pulmonary Emphysema / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate