Background and Aim:
Pulmonary Tuberculosis (PTB) is a common medical and social problem worldwide, especially in developing countries. Currently, management of tuberculosis is essentially medical, and surgery has a little role. Today surgery is usually performed only in patients with tuberculosis when the diagnosis is needed, who have complications, or who have active disease resistant to treatment (MDR TB). The aim of this study is to assess the role and outcome of surgical intervention in patients with multidrugs resistance or complicated pulmonary TB.
Patients and Methods:
Between 2005 and 2013, 70 patients with pulmonary tuberculosis were included. There were 57 males and 13 females with a mean age of 35 years. Preoperative clinical manifestations included coughing with expectoration in (65) patients, hemoptysis in (8), chest distress in (29), weight loss in (70) and night fever in (19). Indications for surgery were: entrapped lung in 15 (21.4%), MDR-PTB in 5 (7%), destroyed lobe in 17 (24%), massive hemoptysis in 5 (7%), empyema with bronchopleural fistula in 9 (12.8%), persistent cavity in 10 (14%).
Results:
The most common procedure were lobectomy 38 (54%), wedge resection 10 (14%), decortication 13 (18.5%), thoracoplasty 1(1.4%), and 8 (11.4%) pneumonectomy. Postoperatively sputum was negative in all patients except one patient who had relapse 6 months later, complications occurred in 17 (24%) patients, there were prolonged air leak in 8 patients, residual space in 2, empyema and bronchopleural fistula in 2 patients, thoracotmy wound infection in 5 patients. There were 5 (7%) mortality cases, 2 of then early postoperative, while 3 late postoperative, respiratory failure is the most common cause of death.
Conclusion:
Surgery associated with medical treatment provides a high cure rate for patients with MDR-TB and those with TB complications with acceptable morbidity and mortality