title: A modified bronchial anastomosis technique for lung transplantation.
abstract: BACKGROUND
  Low rates of major complications have been reported for the intussuscepting bronchial anastomotic technique but stenosis, malacia, and granulation tissue at the anastomosis may cause clinically important morbidity. We hypothesized that a modification of the telescoping technique that improves bronchial wall apposition might be associated with improved bronchial healing and clinical outcomes.
  
  
  METHODS
  The telescoping horizontal mattress "U-stitch" suture technique was modified to incorporate figure-of-eight sutures placed in the cartilaginous wall between each of three intussuscepting U stitches. Serial videotape records of 152 individual anastomoses (99 modified, 53 telescoped) in 118 consecutive operative survivors were retrospectively reviewed by examiners blinded with respect to technique used. Stenosis, airway instability, mucosa quality, and devascularized luminal tissue were graded at 4 to 14 days (initial), 4 to 12 weeks (early), and 6 to 12 months (late) after transplantation.
  
  
  RESULTS
  The incidence of anastomotic stenosis was significantly lower using the modified technique at the initial (p = 0.025) and late (p = 0.015) observations. In the initial phase airway instability (p = 0.015) and devascularization grades (p = 0.001) were also significant lower in the modified group. There were no significant differences in mucosal condition between techniques. The modified telescoping technique was associated with significant survival advantage (mean 17.7%; p = 0.029) by multivariate analysis. The incidence of major airway complications (dehiscences and stenoses required stents) tended to be lower (3% versus 6%) in the modified group.
  
  
  CONCLUSIONS
  The modified telescoping bronchial anastomosis technique is associated with improved early and late bronchial healing and higher 5-year survival without increased major airway complications.
authors.affiliation: Department of Cardiac and Thoracic Surgery, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Carsten
authors.initials: C
authors.lastname: Schröder
authors.forename: Frank
authors.initials: F
authors.lastname: Scholl
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Daon
authors.forename: Andrea
authors.initials: A
authors.lastname: Goodwin
authors.forename: William H
authors.initials: WH
authors.lastname: Frist
authors.forename: John R
authors.initials: JR
authors.lastname: Roberts
authors.forename: Karla G
authors.initials: KG
authors.lastname: Christian
authors.forename: Mathew
authors.initials: M
authors.lastname: Ninan
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Milstone
authors.forename: James E
authors.initials: JE
authors.lastname: Loyd
authors.forename: Walter H
authors.initials: WH
authors.lastname: Merrill
authors.forename: Richard N
authors.initials: RN
authors.lastname: Pierson
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D001980:Bronchi / Q000601:surgery*; D001982:Bronchial Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D001999:Bronchoscopy; D003251:Constriction, Pathologic / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D012131:Respiratory Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D015996:Survival Rate; D013536:Suture Techniques; D016896:Treatment Outcome