Extrapleural pneumonolysis: history of development, current state, and prospects for its use in the surgical treatment of pulmonary tuberculosis. Literature review

Abstract

Tuberculosis (TB) is a major public healthcare problem. The fight against the disease is complicated due to the growing emergence of drug-resistant forms, the treatment of which can be quite difficult. Extrapleural pneumonolysis (EPP) with plombage was widely used to treat cavitary pulmonary tuberculosis in the late 1950s. The EPP surgical method is characterized by the creation of extrapleural space and its filling with plastic material to achieve long-term collapse. Plombage included a number of materials, such as fat, paraffin wax, bone, sponge, gelatin, silicone, methyl methacrylate (Lucite) or polyethylene balls. However, the presence of foreign structures for a long period of time can lead to complications in the form of malignant tumors, erosion of small and large vessels with bleeding, and migration of plombage material. In recent decades, WHO has noted that surgical therapy may play an important role in TB treatment. Collapse surgery may be the only hope for patients who are not eligible for resection-type surgery. Currently, EPP is actively used in leading institutions to treat the most severe patients. This operation is indicated for patients with concomitant diseases, poor functional reserves of the body, as well as advanced tuberculosis, which does not allow resection of healthy lung tissue.