Anastomotic dehiscence

Lung transplantation-bronchial anastomotic dehiscence Cases of bronchial anastomotic dehiscence, most fatal, have been reported in de novo lung transplant patients when sirolimus has been used as part of an immunosuppressive regimen. The safety and efficacy of sirolimus as immunosuppressive therapy have not been established in liver or lung transplant patients, and therefore, such use is not recommended. 

Alberts J.C, Parvaiz A, and Moran B.J (2003) Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorect Dis 5 478-482... 

The most common airway problems are anastomotic dehiscence and bronchial stenosis due to strictures. The reason is mostly a lack of perfusion of the bronchial tree, as the donor airways depend on a retrograde pulmonary-to-bronchial arterial circulation until revascularization of the bronchus wall occurs. Ischaemia is greater on the right main bronchus than on the left, therefore anastomotic healing is better on the left and early stenotic problems or dehiscence occur on the right anastomosis more frequently than on the left side. In the early years of transplantation the en bloc technique was mainly performed with a high incidence of tracheal dehiscence, which prompted the development of bilateral lung transplantation. 

The most common causes of death in the initial hospitalization period or within the first 60 days right after patients are discharged are cardiac-related and primary graft failure (Meyers et al. 1999). Other common causes include parenchyma bleeding, ARDS, sepsis, bacterial pneumonia, and pulmonary embolism and neurological injury (Meyers et al. 1999). Anastomotic dehiscence, a previously common postoperative complication, is now very rare because of improved surgical techniques (Date et al. 1995). Treatment usually consists of overstenting the anastomotic dehiscence via bronchoscopy (Fig. 5.2.9) (SusANTO et al. 1998). 

Airway dehiscence can be suspected when a pneumothorax with a persistent air leak occurs some days after the operation or anastomotic wound healing problems are detected via bronchoscopy. 

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