Our objective was to evaluate the role of surgery in pulmonary tuberculosis and the results achieved in the management of these patients.
A total of 1327 patients (male-823, female-504)underwent surgery for pulmonary tuberculosis in our centre from 1970 to 2004. Pulmonary resections performed in 1115 patients included pneumonectomy in 102 patients (7.6%), lobectomy in 897 patients (67.9%), and segmental resections in 118 patients (8.8%). Bilateral lung resections were performed in 17 patients. Decortication accompanied lung resections in 354 patients and was done as an isolated procedure in 212 patients (15.9%). Thoracoplasty was done in 151 patients. Video Assisted Thoracosopic Surgery was done only in early empyema cases for decortication and to assess the size and site of bronchopleural fistula preoperatively. Surgery was indicated for massive hemoptysis in 562 patients (42.4%), destroyed lung in 82 patients (6.1%) and other causes like persistent fibrocavity with active disease, localized bronchiectasis and chronic suppurative lung lesions. Twelve patients underwent bronchopleural fistula repair with omental patches. Sixteen patients had multidrug resistant tuberculosis and surgery was done for localized lesions in these patients. Clagett’s procedure was done in 10 patients with persistent empyema.
The duration of hospital stay ranged from 7 to 60 days. Overall, 32 patients had recurrence of hemoptysis(5.7%). Emergency re-exploration for postoperative bleeding was performed in 42 patients(3.2%). The other major postoperative complications were wound infection in 89 patients(6.7%), bronchopleural fistula in 64 patients(4.8%), empyema in 31 patients(2.3%) and prolonged air leak in 76 patients(5.6%). Respiratory failuire occured in 6 patients(0.45%). A total of 16 patients(1.2%) died.
Though anti-tuberculous chemotherapy resolved pulmonary tuberculosis in a majority of patients, there are still definite indications in which surgical management plays a vital role.
Surgical management of pulmonary tuberculosis is adjuvant in multidrug resistant thick walled cavitary tuberculosis and life saving in localised cavity causing life threatening massive hemoptysis and fastens the recovery of patients with mulctiloculated complicated pleural efusions.
Velappan Jayaraman, None.