The role of surgery in the management of pleuropulmonary tuberculosis - seven years' experience at a single institution

Abstract

Pleuropulmonary tuberculosis (TB) is a relatively frequent condition (the incidence of (TB) was 176/100,000 in our county in 2004) and some of these patients with TB are undergoing surgical interventions. The authors share their experience in surgical treatment of pleuropulmonary tuberculosis, based on minimal invasive techniques such as VATS and filling the residual cavities with muscle or skin-muscle grafts. The authors are retrospectively revising 144 patients between 1 January 2001 and 31 December 2007 who underwent surgical treatment for tuberculosis in this period. Two hundred and thirteen surgical procedures were performed for pleuropulmonary tuberculosis, representing 4% of all the procedures done in the department. For most of the patients the etiological diagnosis was not established until the operations, all the patients were sputum-negative. The diagnoses at the admittance were: pulmonary nodules or tumors (42 patients), pleural collections (46), pleural thickening and post-tuberculosis syndromes (46), fibrocavitary tuberculosis (6), and tuberculous pericarditis (4). Of all the procedures applied, 14 were pulmonary resections, 50 atypical (wedge) resections, 70 video-assisted thoracic surgery (VATS) procedures, and nine patients needed muscle or skin-musle flap for residual pleural cavities. Eleven patients (7.6%) had to undergo secondary surgery due to complications. No in-hospital mortality was registered. The mean hospitalisation period was 10.1+/-4.2 (S.D.) days.

Outcomes of Video-Assisted Thoracic Surgical Decortication in 274 Patients with Tuberculous Empyema

“…However, it remains unclear whether VATS is more useful in such advanced disease stage, since more studies with large patient pool are required to support the data obtained in isolated clinical observations. 19,20) It was suggested that VATS for tuberculous empyema is effective only for stage II disease, and open thoracotomy and decortication are indicated for stage III empyema. 19) The conversion and reoperation rates were low for early stages, suggesting the thoracoscopic approach as effective and reasonable first option for most patients with complex pleural effusions and empyema.…”

Surgery and pleuro-pulmonary tuberculosis: a scientific literature review

“…If pleural empyema occurs with radiologic TB signs, conservative treatment with prolonged chest tube aspiration is strongly recommended. Surgical therapy (open approach) is suggested only for cases with major residual pleural thickenings (89).…”

Complex space-filling procedures for intrathoracic infections — personal experience with 76 consecutive cases☆

“…However, considering the increasing incidence of TB [4,9] and other intrathoracic infections, this kind of surgery may be required more often in the future.…”

“…Despite significant advances in the treatment of thoracic infections, they remain a problem for the modern thoracic surgeon [1][2][3][4]. Patients not amenable to lung resection or decortication remain a major challenge since they often require prolonged hospitalisation, multiple procedures and mutilant surgery [5].…”