Simple endoscopic estimation to predict anastomotic complications after bronchoplastic procedures

Area of Science:

• Thoracic surgery
• Surgical oncology
• Endoscopic diagnostics

Background:

• Anastomotic complications following bronchoplastic procedures can lead to significant morbidity.
• Early detection is crucial for effective management and improved patient outcomes.
• Endoscopic evaluation offers a direct method for assessing the anastomosis.

Purpose of the Study:

• To identify key endoscopic findings predictive of anastomotic complications after bronchoplasty.
• To evaluate the accuracy of these findings at specific postoperative time points.

Main Methods:

• Retrospective analysis of 190 patients undergoing bronchoplasty with serial bronchoscopies at 1 and 2 weeks post-surgery.
• Assessment of endoscopic features including slough characteristics (area, color, shape) and mucosal appearance.
• Correlation of endoscopic findings with the incidence of anastomotic complications like fistula and stenosis.

Main Results:

• Anastomotic abnormalities occurred in 7.4% of patients, with fistulas (5.8%) and stenosis (3.7%) being most common.
• Slough worsening between weeks 1 and 2 post-surgery was observed in 53.7% of patients, making 2-week assessment more informative.
• Endoscopic findings of circular slough, dark slough color, and depression at 2 weeks post-surgery showed high negative predictive values for complications (98.1%-99.4%).

Conclusions:

• Endoscopic assessment of anastomotic slough 2 weeks after bronchoplasty is a reliable method for predicting complications.
• Circular slough, dark slough color, and depression are significant predictors of anastomotic abnormalities.
• The absence of these three endoscopic findings indicates a very low risk of anastomotic complications.