[Surgical policy in tuberculous pleurisy]

Area of Science:

• Pulmonology
• Infectious Diseases
• Thoracic Surgery

Background:

• Tuberculous pleurisy is a significant extrapulmonary manifestation of tuberculosis.
• Understanding the disease's progression is crucial for effective management.
• Current treatment strategies require optimization based on disease staging.

Observation:

• Analysis of 287 tuberculous pleurisy cases revealed four distinct phases: free, partially encysted, encysted, and adhesive pleurisy.
• A treatment algorithm was developed, correlating interventions with the identified disease phases.
• Thoracoscopy was performed in 66 patients, with its efficacy evaluated across different stages.

Findings:

• Thoracoscopy is less effective in the adhesive phase of tuberculous pleurisy, especially with residual cavities.
• Thoracotomy with pleurectomy and decortication (performed in 39 cases) is preferred for advanced adhesive stages.
• Early implementation of draining procedures and surgical interventions leads to faster recovery.

Implications:

• The proposed algorithm aids clinicians in selecting appropriate interventions for tuberculous pleurisy based on its phase.
• Optimized treatment timing can reduce the duration of illness and minimize long-term sequelae.
• This approach enhances patient outcomes in managing tuberculous pleurisy.