Surgical treatment for pulmonary tuberculosis in childhood

Abstract

Summary Seventy-one children who were treated for pulmonary tuberculosis at High Wood Hospital between 1949 and 1958 and who had surgical treatment at the London Chest Hospital were selected for study. Eighteen of these were suffering from primary tuberculosis or its complications and 53 had chronic pulmonary tuberculosis. All except two received chemotherapy. The indications for surgery are discussed. Between 1954 and 1958, 3·3 per cent. of children with primary tuberculosis or its complications and 14·6 per cent. of those with chronic pulmonary tuberculosis were selected for surgical treatment. The various surgical procedures employed in treating primary and chronic pulmonary tuberculosis and the results are discussed. In patients selected for surgery resection is considered to be the method of choice, together with adenectomy in the case of enlarged glands causing symptoms. Extra-pleural pneumothorax has been abandoned and thoracoplasty is contra-indicated in children. The relative freedom from post-operative complications and the good radiological results obtained by comparison with similar surgical treatment in adults is emphasised. All the patients were followed up. There were no deaths. Only one child with primary tuberculosis failed to do well and developed renal and cervical glandular tuberculosis three years after operation. Among the children with chronic pulmonary tuberculosis treated surgically only two relapsed, both following extra-pleural pneumothoraces. The importance of adequate chemotherapy is stressed. It is concluded that surgical treatment should be confined to a small number of patients with persistent symptoms due to the various complications of primary tuberculosis, while in children with chronic pulmonary tuberculosis the indications for surgery are the same as those in adults.