Surgery for Pulmonary Tuberculosis and Its Indications

Abstract

In the early twentieth century, treatment of pulmonary tuberculosis (PTB) consisted not only of bed rest, proper nutrition, and exposure to sunlight, but also of medical procedures such as surgery or artificial pneumothorax or pneumoperitoneum, because there were no antibacterial drugs. With the availability of anti-tuberculosis (TB) drugs (isoniazid, rifampin, etc.), the majority of TB can be cured by clinical treatment with proper drug regimens. Surgical procedures are used only when necessary. In recent years, the emergence of drug-resistant TB, especially MDR-TB and XDR-TB, expanded the surgical indications, which include tuberculous cavity, large tuberculoma, tuberculous empyema, and recurrent hemoptysis. The medical team must consider the indications and contraindications for surgery and strictly follow preoperative and postoperative anti-TB chemical treatment. Performing 3–6 months of anti-PTB treatment is the most important measure to take before PTB surgery. The two main methods of PTB surgery are collapse therapy (mostly abandoned in the present day) and removal of primary lesions. The primary techniques associated with lesion removal are wedge resection, lung segment resection, lobectomy, and pneumonectomy. The most common complications associated with PTB surgery are bleeding, bronchopleural fistula (BPF), and empyema. PTB surgery plays an important role in diminishing and eliminating sources of PTB infection.