Surgery for pulmonary tuberculosis

Abstract

The role of thoracic surgery in pulmonary tuberculosis, in either a diagnostic or a therapeutic role, is well established. This review aims to underline the current indications for lung resection, surgical strategy and outcomes associated with surgery. There has been a renewed interest in surgery, mainly in the multidrug-resistant tuberculosis (MDRTB) group as an adjunct to medical therapy. Lung resection in this group of patients has been undertaken with acceptable morbidity and mortality, and with cure rates of over 90%. The current strategy favours early surgical intervention for patients with multidrug-resistant tuberculosis to prevent the development of bilateral disease. Early surgery for haemoptysis is advocated, for sometimes it is necessary to operate on these patients without a full course of antituberculous therapy. Medical stabilization and early inpatient surgery is favoured in view of the excessive mortality associated with emergency surgery. There is still no consensus on the management of the bronchial stump at the time of lung resection, although the current trend favours closure, either sutured or stapled, without muscle reinforcement. Lung resection for pulmonary tuberculosis, in carefully selected and prepared patients, is safe with acceptable morbidity and mortality.