Surgical intervention in bronchiectasis and pulmonary tuberculosis

Bronchiectasis and pulmonary tuberculosis (TB) remain common causes of chronic respiratory morbidity worldwide, despite major advances in antimicrobial therapy and structured airway clearance strategies. In a subset of patients, medical treatment alone is insufficient, and surgical intervention may be required when disease is anatomically localised or when serious complications develop. From a surgical perspective, resection of non-functional, chronically infected lung segments in bronchiectasis can lead to sustained symptom improvement, fewer exacerbations, and effective control of haemoptysis when patients are appropriately selected. In pulmonary TB, surgery continues to serve both diagnostic and therapeutic purposes. Operative intervention may be necessary when noninvasive investigations fail to establish a diagnosis, or when persistent cavitary disease, drug-resistant infection, or structural complications such as destroyed lung, chronic empyema, or bronchopleural fistula are present. Current respiratory guidelines emphasise careful medical optimisation and multidisciplinary assessment before surgical referral, highlighting the importance of appropriate patient selection. This narrative educational review focuses on practical principles that guide surgical decision-making in bronchiectasis and pulmonary TB. Indications for surgery, contraindications to operative intervention, and criteria for referral for lung transplantation are discussed, with the aim of supporting clinicians involved in the care of patients with complex structural lung disease.