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Surgical Versus Medical Management of Anastomotic Dehiscence

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From Thoracic Surgery to Interventional Pulmonology

Part of the book series: Respiratory Medicine ((RM))

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Abstract

Anastomotic dehiscence is one of the most serious complications following lung transplantation characterized by necrosis leading to full-thickness anastomotic separation of the bronchial wall. While some of the major risk factors associated with anastomotic dehiscence include surgical technique, perioperative steroids, acute rejection, infection, inadequate organ preservation, and immunosuppression, the primary cause is thought to be anastomotic ischemia. The severity of anastomotic dehiscence determines if bronchoscopic treatments will be successful. The use of self-expanding metallic stents (SEMS) is the cornerstone of the bronchoscopic treatment of severe anastomotic dehiscence without complete anastomotic breakdown. Various surgical techniques have been developed and refined to reduce the incidence of anastomotic dehiscence and airway complications. Regardless of classification schemes, most cases of anastomotic dehiscence are incomplete. There are no published guidelines on absolute indicators for failure of conservative management as an indication for operative intervention for anastomotic dehiscence. Airway reanastomosis in these circumstances is challenging due to the re-operative nature of the field, the poor tissue quality, relative ischemia, and, in many cases, the presence of infection. Allograft pneumonectomy remains an option of last resort with the possibility of re-transplantation depending upon patient status and organ availability.

** Each author has contributed equally to this manuscript

*** This manuscript has not been submitted for publication in any other journals

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Conflicts of Interest

We declare that we have no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Inova Schar Cancer Institute, Inova Fairfax Hospital, Falls Church, VA, USA

    Amit K. Mahajan & Priya P. Patel

  2. Department of Thoracic and Cardiovascular Surgery, Loyola University Health System, Maywood, IL, USA

    Bethany Hampole & Wickii T. Vigneswaran

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  1. Amit K. Mahajan
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  2. Bethany Hampole
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  3. Priya P. Patel
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  4. Wickii T. Vigneswaran
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Corresponding author

Correspondence to Amit K. Mahajan .

Editor information

Editors and Affiliations

  1. Director of Interventional Pulmonology, Director of Pulmonary Rehabilitation, Pulmonary & Critical Care Medicine, Wyoming Medical Center, Casper, WY, USA

    J. Francis Turner, Jr.

  2. Pulmonary and Critical Care, Louis A Johnson VA Medical Center, Clarksburg, WV, USA

    Prasoon Jain

  3. Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada

    Kazuhiro Yasufuku

  4. Buoncore Family Endowed Chair in Lung Transplantation, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA

    Atul C. Mehta

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Mahajan, A.K., Hampole, B., Patel, P.P., Vigneswaran, W.T. (2021). Surgical Versus Medical Management of Anastomotic Dehiscence. In: Turner, Jr., J.F., Jain, P., Yasufuku, K., Mehta, A.C. (eds) From Thoracic Surgery to Interventional Pulmonology. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-80298-1_9

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  • DOI: https://doi.org/10.1007/978-3-030-80298-1_9

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  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-80297-4

  • Online ISBN: 978-3-030-80298-1

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