• Yukio Watanabe, Shinji Sasada, Takehiro Izumo, Yukiko Nakamura, Christine Chavez, Shun-ichi Watanabe, and Takaaki Tsuchida.
• Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
• Ann. Thorac. Surg. 2014 Dec 1;98(6):2200-2.

AbstractA 64-year-old woman underwent tracheal sleeve resection for adenocarcinoma. Thirteen months later minimal granuloma occurred at the anastomosis. Subsequently she had dyspnea from obstruction caused by the increasing size of the granuloma, which necessitated 4 repeated endobronchial debulking procedures and topical mitomycin C (MMC) application. However, the symptoms and granulation failed to resolve. Eventually, the granulation tissue and pledgeted sutures were removed from the anastomotic site using rigid bronchoscopy. Follow-up after 8 months showed no recurrence of symptoms, and the granuloma had resolved. Despite improvements in surgical suture material, removal of stitches should still be considered in the management of anastomotic obstruction caused by indolent and intractable granulation after tracheal resection or bronchoplasty.Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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