Anastomotic healing

Kuzu M. A, Tanik A, Kale I. T, Aslar A. K, Koksoy C, and Terzi C, (2000) Effect of Ischemia/Reperfusion as a Systemic Phenomenon on Anastomotic Healing in the Left Colon. World J Surg 24 990-994... 

Surgeons in the United States, Canada and Europe performed about 40 human lung transplantations between Hardy s operation and the end of 1980. But success was limited by anastomotic healing problems immediately after the operation, technical complications, infections and the inability to differentiate infection from rejection. Improvement of bronchial anastomotic healing was achieved by... 

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. 

Several studies have demonstrated anti-adhesive effects of modified chitosan based cross-linked hydrogels. A gel was synthesized from succinyl chitosan and dextran aldehyde, and its efficacy in reducing adhesion formation in the intraperitoneal cavity was evaluated in rat models [151]. The surgical procedure was performed by laparotomy and either cecal abrasion or anastomotic simulation by enterotomy of the cecum with primary closure. After 21 days postoperatively, adhesions were significantly reduced for the treatment group in both the models. There was no adverse effect on wound healing. 

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. 

Scheduled bronchoscopies are performed routinely during the first year after transplantation at most transplant centres. Inspection of the anastomotic sutures, control of anastomotic wound healing, BAL with microbiologic cultures and transbronchial biopsies are taken to document lung tissue quality and to diagnose acute or chronic lung rejection, invasive infections and eventually to perform interventional procedures such as dilatation or stenting of bronchial stenosis. 

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