Pulmonary tuberculosis and the surgeon

Though medical management is the cornerstone of management of pleuropulmonary tuberculosis today, surgery may play a significant collaborative role, both in its diagnosis and in its treatment in well defined clinical scenarios. In drug resistant tuberculosis, empyemas and bronchial stenosis, surgery may play a very important role and may also successfully resolve symptoms produced by TB sequelae such as symptomatic bronchiectasis and aspergillomas. Recent advances in thoracic surgery and the use of minimally invasive surgical techniques has made surgical options safer and with a significant decrease in morbidity and mortality, thereby enabling surgical solutions for a bigger number of tuberculosis related problems. It is important for all clinicians treating tuberculosis to understand the indications for surgery and to work together with surgeons so that the most appropriate treatment can be offered to the patient at the correct time. Perhaps the time has also come to explore the role of multidisciplinary teams to enable this to happen. This review attempts to define the role and timing of surgery in the management of pleuropulmonary tuberculosis.