TECHNIQUES FOR BRONCHIAL ANASTOMOSIS

Background: Many techniques have been described to optimize the constr uction of the bronchial anastomosis in lung transplantation. Over the past 60 months we have performed 86 bronchial anastomoses in 70 patien ts receiving single lung or bilateral single lung transplants. Methods : No anastomosis was wrapped and no attempt was made at revascularizat ion of bronchial arteries. A continuous nonabsorbable suturing techniq ue was used in all cases. Standard triple-drug immunotherapy with cycl osporine, azathioprine, and prednisone (starting at day 7) was used fo r each patient. Results: There were no anastomotic leaks, and seven st enoses were identified in five patients (7%). All complications were m anaged 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 f or questionable anastomotic viability but without evidence of airway n ecrosis or obstruction. This patient died of infection at 16 days. Ano ther patient died with stents in place at 71 days. In the four remaini ng patients, all stents have been removed after a mean of 310 days. Th ese patients were followed up with serial bronchoscopy and were withou t evidence of recurrent obstruction at 2, 34, 35, and 36 months. Six o f seven stenoses occurred in patients with cystic fibrosis. In each pa tient where stenosis developed the anastomosis was telescoped. Since a bandoning the telescoping technique in the remaining 50 anastomoses (1 4 in patients with cystic fibrosis), no dehiscence or stenosis was enc ountered. Conclusions: These data suggest that elaborate techniques ai med at construction of the bronchial anastomosis are not necessary. Mo reover, attempts at telescoping may be detrimental. Patients with cyst ic fibrosis may be a population at higher risk for anastomotic complic ations. Airway complications can be managed conservatively with good r esults and little risk to the patient.