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Role of surgery in pulmonary tuberculosis
Jorge G Freixinet1, Juan J Rivas, Felipe Rodríguez De Castro
1Thoracic Surgery Service, University Hospital Dr. Negrín, Las Palmas Gran Canaria, Spain.
Background:
The purpose of our study was to analyze current indications for surgery in tuberculosis (TB). We present our experience with TB patients presenting with indications for surgery between 1990 and 1998.
Material/Methods:
The indications for surgical intervention included 25 cases of pulmonary aspergilloma, 19 cases of pneumothorax, 16 cases of pulmonary nodes and masses without histological diagnosis, 15 cases of bronchiectasis, 12 cases of massive hemoptysis, 12 cases of pleural empyema, and 33 cases of other complications. No patients with multidrug-resistant tuberculosis required surgical intervention, although 56 were treated during this period.
Results:
The techniques utilized included lobectomy in 45 cases, pleural drainage in 32 cases, segmented pulmonary resection in 32 cases, surgical procedures on the thoracic wall in 17 cases, pneumonectomy in 10 cases, pleuropulmonary decortication in 8 cases, mediastinoscopy in 6 cases, and thoracoscopy in 5 cases. In 25 cases two or more procedures were performed on the same patient. In 36 cases (27.3%) there were complications, of which persistent air leakage after pulmonary resection was the most frequent (n=10). There was a mortality rate of 5.3% (7
Conclusions:
In our experience, surgery in the treatment of TB is indicated to resolve sequelae or complications, since cases of simple or multidrug-resistant TB can be managed pharmacologically. The morbidity and mortality rates in our series were acceptable.