Purpose The bronchial anastomosis technique for lung transplantation (LTx) is still subject to open discussion and anastomotic complications are one of the major concerns in the field. We aimed to compare two different surgical techniques, continuous two-stitch suture (CS) versus interrupted suture for cartilaginous wall (IS), analyzing airway complications requiring intervention (ACRI). Methods Patients undergoing LTx between January 2015 and December 2020 were included in this single institution retrospective study. ACRI were classified following the 2018 ISHLT consensus and analyzed comparing three different groups of patients according to surgical technique: Group A, both anastomosis performed with CS; Group B, both with IS; and Group C, IS for one side and CS for the contralateral side. Results A total of 461 anastomoses were performed in 245 patients. The incidence of ACRI was 5.7% per patient (14/245) and 3.7% per anastomosis (17/461). Irrespective of 57 unregistered anastomotic technique, a total of 164 were performed with IS (40.6%) and 240 with CS (59.4%). Right-sided anastomoses were affected in 68.4%. Continuous suture was involved in 12 out of 17 (70.6%) ACRI (p=0.184). No statistical differences (Image 1) were found among Group A (109 patients), B (65 patients) or C (40 patients) in terms of ACRI incidence, demographic variables, transplant outcomes or overall survival (log-rank p=0.513). Endoscopic treatment was successful in 12 patients (85.7%). Retransplantation was necessary in 2 patients who developed critical stenosis. Overall survival was similar between patients with and without ACRI (85% vs. 87% at 1st year, 85% vs. 80% at 3rd year; log-rank, p=0.800). Conclusion Although it seems that ACRI after LTx are more frequent with CS technique, there are no statistical differences compared to IS. Endoscopic treatment offers satisfactory results in the vast majority of bronchial complications, leading to comparable short and mid-term outcomes. The bronchial anastomosis technique for lung transplantation (LTx) is still subject to open discussion and anastomotic complications are one of the major concerns in the field. We aimed to compare two different surgical techniques, continuous two-stitch suture (CS) versus interrupted suture for cartilaginous wall (IS), analyzing airway complications requiring intervention (ACRI). Patients undergoing LTx between January 2015 and December 2020 were included in this single institution retrospective study. ACRI were classified following the 2018 ISHLT consensus and analyzed comparing three different groups of patients according to surgical technique: Group A, both anastomosis performed with CS; Group B, both with IS; and Group C, IS for one side and CS for the contralateral side. A total of 461 anastomoses were performed in 245 patients. The incidence of ACRI was 5.7% per patient (14/245) and 3.7% per anastomosis (17/461). Irrespective of 57 unregistered anastomotic technique, a total of 164 were performed with IS (40.6%) and 240 with CS (59.4%). Right-sided anastomoses were affected in 68.4%. Continuous suture was involved in 12 out of 17 (70.6%) ACRI (p=0.184). No statistical differences (Image 1) were found among Group A (109 patients), B (65 patients) or C (40 patients) in terms of ACRI incidence, demographic variables, transplant outcomes or overall survival (log-rank p=0.513). Endoscopic treatment was successful in 12 patients (85.7%). Retransplantation was necessary in 2 patients who developed critical stenosis. Overall survival was similar between patients with and without ACRI (85% vs. 87% at 1st year, 85% vs. 80% at 3rd year; log-rank, p=0.800). Although it seems that ACRI after LTx are more frequent with CS technique, there are no statistical differences compared to IS. Endoscopic treatment offers satisfactory results in the vast majority of bronchial complications, leading to comparable short and mid-term outcomes.