Source: International Congress 2015 – Case series and clinical conundrums in TB
Disease area: Respiratory infections

Abstract

Objective: To determine the utility of surgery in patients with bilateral fibro-cavernous pulmonary TB.Methods: we studied 53 TB patients, aged 18 to 61 years, who were admitted between August 2012 to December 2014, 41(77.4%) of them were males.All the patients had bilateral pulmonary fibro-cavernous TB, with complete destruction of one lung in 19(35.8%) cases. Previous TB history was from 1 to 22 years). Forty patients (75.5%) were smear-positive, 18(34.0%) had MDR TB, 25(47.2%) had XDR TB at the time of admission. Complicated TB course was observed in 43(81.1%) patients. Six patients previously had surgery for pulmonary TB.Results: A total of 120 operations performed in 53 patients as an adjunct to TB therapy. Patients were divided to groups. In group 1, (n=15) lung resection (LR) was done at the most affected side, followed by LR of valve bronchial blockade (VBB) on another side. In group 2, (n=19) we started with VBB at minimally affected side, followed by contra-lateral pneumonectomy. Selective thoracoplasty (STP) at initial side was performed when necessary. In group 3 (n=19) patients had advanced sub-total TB, series of VBB and STP were performed.Complications were observed in 5(9.4%) patients, no mortality occur. Clinical and X-Ray improvement was observed in all the patients. Smear conversion was found in 14(93.3%), 15(78.9%), 15(78.9%) patients in groups 1, 2 and 3 respectively. Average duration of hospital stay was 57.2 days.Conclusions: Most patients with bilateral fibrous-cavernous pulmonary TB are suitable for surgery, with promising treatment results in shorter period. However, surgery for advanced TB requires an individual approach and should only be carried out in selected institutions.


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Kirill Vladimirov (St.Petersburg, Russian Federation), Pyotr Yablonskii, Armen Avetisian, Galina Marfina, Grigorii Kudriashov, Kirill Vladimirov, Igor Vasilev, Evgenia Popova. Consecutive surgical treatment for bilateral fibro-cavernous pulmonary TB. Eur Respir J 2015; 46: Suppl. 59, 2764

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