Tracheobronchial resection and reconstruction: to wrap or not to wrap the anastomosis?

Two opinions in tracheobronchial resection and reconstruction regarding the management of airway anastomosis remain controversial: whether to wrap the anastomosis with surrounding tissue or leave the anastomosis without additional embedding. This study aims to explore the relationship between the choice of anastomotic wrapping and anastomotic complications in tracheobronchial surgery.

Patients who underwent tracheobronchial surgery between January 2019 and December 2021 were retrospectively analyzed. A total of 95 patients were enrolled, and their age and comorbidities were quantified using the age-adjusted Charlson comorbidity index. Based on the length of resection and neoadjuvant therapy, the cases were categorized into the complex surgery group and the standard surgery group. Each group was further divided into wrapped and non-wrapped subgroups.

The complex surgery group included 42 patients (wrapped subgroup: 32, non-wrapped subgroup: 10), and the standard surgery group comprised 53 patients (wrapped subgroup: 32, non-wrapped subgroup: 21). In the complex surgery group, the wrapped subgroup exhibited a significantly lower short-term postoperative anastomotic complication rate compared to the non-wrapped subgroup (P=0.004). This included lower rates of anastomotic mild necrosis or stenosis (18.8% vs. 20.0%) and anastomotic rupture or fistula (0% vs. 40.0%), as well as a lower 30-day mortality rate (0% vs. 30%, P=0.01). No statistically significant differences were observed in the standard surgery group.

The wrapping procedure demonstrated a relatively positive effect in minimizing the risk of short-term anastomotic complications in complex tracheobronchial surgery without impacting long-term anastomotic complications. However, it did not play a significant role in standard tracheobronchial surgery.