EndToEnd Tracheal and Bronchial Anastomosis

Glück and Zeller, in 1881, demonstrated healing after end-to-end tracheal anastomosis in dogs and believed the technique could be applied in man.33 Colley, in 1895, in order to avoid stenosis, tried elliptical and bayonet anastomoses in dogs after resecting five rings.34 Primary anastomosis of the cervical trachea, after limited resection for post-traumatic stenosis, followed in 1886 by Küster, apparently the first in man.35 In 1898, Bruns performed an extended lateral excision of a papillary tumor in the cervical trachea, but managed the tracheal defect by packing and with a cannula.36 Complex methods for repair of cervical tracheal defects, with skin or fascia lata, were also explored in the early twentieth century by Nowakowski in 1909 and by Levit in 1912, among others.37,38 Eiselsberg successfully performed a second resection of 1.5 cm of trachea in one patient.39 Mathey and colleagues commented in 1966, "This type of radical tracheal surgery was then forgotten for half a century."40

The era of open thoracic surgery had arrived. By 1936, Churchill had refined the technique of lobectomy to achieve a 2.6% mortality rate.41 As interest in bronchial and tracheal surgery grew by the mid-twentieth century, laboratory experiments confirmed that healing followed end-to-end anastomosis of both bronchi and trachea, although sometimes with stenosis.28-30,42-45

Bronchial repair after trauma proved the feasibility of airway reconstruction. Sanger described bronchial repair in patients during World War II.46 In 1949, Griffith resected a stricture and anastomosed the bronchus 3 months after rupture.47 Other late repairs of ruptured bronchi followed.48 Scannell first performed immediate repair of a bronchus ruptured during closed injury in 1951.49 Belcher in 1950 and Mathey and Oustrieres in 1951 reported reanastomosis of main bronchi after accidental division during surgery.50,51

Earlier cautious enlargement of bronchial stenosis by wire-supported dermal grafts were replaced by resection and reconstruction.52,53 The technique was applied to low-grade tumors and to carcinomas as sleeve lobectomy evolved.54-58 The evolution of sleeve lobectomy is described in more detail in Chapter 16, "Bronchial Sleeve Resection." Concurrent vascular sleeve resection was also pursued by Johnston and Jones.59 Main bronchial resection without removal of lung tissue was extensively described by Newton and colleagues.60

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