Surgical Treatment in Tuberculosis

Despite recent advances in the pharmacologic treatment of tuberculosis, some patients are left with residual or persistent sequels that could benefit from surgical intervention.

Most experts believe that surgical treatment is rarely necessary in patients with pansensitive tuberculosis, and is only necessary in case of complications, such as massive hemoptysis, empyema, bronchopleural fistula, etc.

The main indication for surgical treatment is MDR/XDR-TB. Surgical treatment in pulmonary MDR-TB is usually indicated in patients with inadequate response to medical therapy and localized lung lesions.

Indications for surgical treatment in tuberculosis can be classified as emergency surgery, urgent surgery, and elective surgery. It is recommended, when possible, that chemotherapy should be administered for at least three months before surgery to reduce the bacillary load and reduce the risk of complications.

There are four essential criteria that a patient must fulfill to be considered as a candidate for surgery in MDR-TB:

1. The patient must have localized disease and adequate respiratory function (forced expiratory volume in one second [FEV-1] ≥1.5 L in cases of lobectomy and ≥2.0 L for pneumonectomy) that will allow the surgical removal of the lesion.

2. The mycobacterial strain causing the disease must have a complex resistant profile, a characteristic associated with a high risk of treatment failure or relapse.

3. Lung tissue, including the airway around the resection margins, should be free of disease to reduce the risk of fistula at the bronchial stump.

4. The availability of enough efficient second-line drugs for treatment after surgery.

Keywords: Emergency surgery, Fistula, Lobectomy, Pneumonectomy, Surgery, Urgent surgery.Emergency surgery, Fistula, Lobectomy, Pneumonectomy, Surgery, Urgent surgery.