Role of surgery in the treatment of pulmonary tuberculosis

The records of 9939 patients hospitalized for tuberculosis between 1963 and 1972 inclusive were reviewed with respect to patients who were treated surgically. During this period there was a steady decline in the number of patients thus treated; the success of antimicrobial drug therapy has altered the frequency of various surgical procedures, and pulmonary resection is now the procedure of choice, with a growing reluctance to perform segmental resection. Morbidity and complications among the patients in this series have been within acceptable limits. The problem of residual space has been minimal. Bronchopleural fistula with empyema (incidence, 3.1%) has been the most serious complication, accounting for the largest proportion of deaths. The mortality of 2.8% is comparable to that reported in the literature. Though mild to moderate respiratory insufficiency developed in some patients, none was seriously incapacitated. The majority of surviving patients have remained well, with their disease under control. In a number of patients reactivation of the disease occurred, probably because of conservative resection and discontinuance of drug therapy due to misunderstanding between patient and physician.