Superiority of end-to-end versus telescoped bronchial anastomosis in single lung transplantation for pulmonary emphysema

Objective: To assess the influence of surgical technique (telescoped versus end-to-end anastomosis) on the incidence of bronchial anastomotic complica tions in patients who underwent single lung transplantation for pulmonary e mphysema. Methods: Seventy-six adult recipients of single lung transplants for pulmon ary emphysema were evaluated for the presence of 3 types of major bronchial anastomotic complications: ischemia, dehiscence, and severe stenosis. Surg ical technique, clinical course, and mortality were reviewed retrospectivel y. Results: The 3 major complications were observed in 11 (34%; ischemia), 8 ( 25%; dehiscence), and 11 (33%; severe stenosis) of 32 telescoped bronchial anastomoses. In contrast, ischemia, dehiscence, and severe stenosis occurre d in only 4 (9%), 1 (2%), and 2 (5%) of 44 end-to-end anastomoses (P = .008 7, 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%) telesc oped anastomoses required stent placement as compared with only 2 (5%) end- to-end anastomoses (P = .1244). Early postoperative pneumonia was more comm on 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 telescope d anastomosis group (mean survival 1045 +/- 145 days) as compared with the end-to-end group (mean survival 1289 +/- 156 days), but these differences d id not achieve statistical significance (P = .2410). Conclusions: In patients who underwent single lung transplantation for pulm onary emphysema, telescoped anastomoses were associated with a higher incid ence of bronchial anastomotic complications than end-to-end anastomoses.