Resection and concomitant thoracoplasty in the treatment of pulmonary tuberculosis.

Abstract

This paper deals with 137 cases of resection and concomitant thoracoplasty in patients operated upon between February, 1953, and August, 1958. During the same period an additional 211 resections were performed in which thoracoplasty was considered unnecessary at the time. Many thoracic surgeons believe that thoracoplasty, whether performed earlier, concomitantly, or later, in selected cases would offer better protection for patients with pulmonary tuberculosis who have had resection of a lung or of a large upper portion of a lung. This is because of the immediate space problem and the later danger of reactivation of residual disease. Steele carried out a survey among Veterans Administration hospitals regarding the surgical management of pulmonary tuberculosis and included, among other problems, the use of space-reducing procedures. He found that in approximately 50 per cent of hospitals, from which answers were obtained, moderate to frequent use of concomitant thoracoplasty was reported; in others either prior or subsequent thoracoplasties were performed (1). From this study it becomes obvious that many surgeons consider that it is no longer a question of whether a tailoring procedure should or should not be done in a large resection, but when it should be done. Iverson and associates first published a report on three cases of pneumonectomy for tuberculosis followed by immediate thoracoplasty in 1949, and a report on an additional seven cases in 1950 (2, 3). In the same year, 1950, Samson and co-workers reported seventeen cases of upper lobectomy and nine cases of pneumonectomy combined with concomitant thoracoplasty (4). Conklin and associates added thirty-eight combined resection-thoracoplasties a year later (5). Despite the voluminous publications in the litera-