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Surgical management of airway obstruction in primary tuberculosis in children
K A Papagiannopoulos1, A G Linegar, D G Harris
1Department of Cardiothoracic Surgery, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa. kpapagiannopoulos@yahoo.com
Insights
Surgical enucleation of mediastinal lymph nodes effectively treats airway obstruction in pediatric lymphobronchial tuberculosis. This safe procedure offers symptom relief and positive long-term outcomes for affected children.
Area of Science:
- Pediatric Surgery
- Pulmonology
- Infectious Diseases
Background:
- Lymphobronchial tuberculosis can cause severe airway obstruction in infants and young children.
- Surgical intervention is considered for managing this critical condition when conservative measures fail.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical enucleation of mediastinal lymph nodes in pediatric patients with lymphobronchial tuberculosis causing airway obstruction.
Main Methods:
- A retrospective review of nine pediatric patients (5-28 months old) who underwent surgery for lymphobronchial tuberculosis over a 4-year period.
- All patients received posterolateral thoracotomies, with lymph node dissection and enucleation performed to relieve airway compression.
- Six patients required preoperative mechanical ventilation due to respiratory failure.
Main Results:
- All nine patients demonstrated significant clinical improvement post-surgery.
- Patients were successfully weaned from mechanical ventilation within 24-72 hours postoperatively.
- Seven patients with long-term follow-up remained symptom-free, indicating sustained positive outcomes.
Conclusions:
- Enucleation of mediastinal lymph nodes is a safe and effective surgical approach for pediatric airway obstruction caused by lymphobronchial tuberculosis.
- The procedure provides successful relief from obstruction with minimal complications when performed cautiously, avoiding excessive dissection.
Background:
The role of surgery in the management of airway obstruction from lymphobronchial tuberculosis is discussed in the present article.
Methods:
Nine patients were operated on over a 4-year period and are currently presented. The age of the patients ranged between 5 and 28 months and 7 patients were male. Six patients required preoperative ventilation due to respiratory failure and all received standard posterolateral thoracotomies. Partial dissection and enucleation of bulky lymph nodes was performed in all but 1 patient. In that patient, the group of lymph nodes could be removed fully, including the sheath.
Results:
All patients showed marked improvement and were weaned off the ventilator between 24 and 72 hours postoperatively. Long term follow-up was available in 7 patients and they are all doing well and are free of symptoms.
Conclusions:
Enucleation of mediastinal lymph nodes obstructing the airways in young patients with lymphobronchial tuberculosis is safe. It successfully relieves obstruction and is devoid of complication providing that incision, evacuation, and curettage of lymph nodes is performed avoiding overzealous dissection.