Surgery For PTB
Ans: Tuberculosis of lung & Pleura is very common.This is known as Pleuro Parenchymal Tuberculosis.Usually they are treated medically with Anti TB drugs(ATD).But there are certain conditions where they cannot be treated only by ATD’s.Surgical management is an important armantarium.
Indications For Operations:
Ans: Massive Haemoptysis (> 600 ml in 24 hrs)
Severe Cavitation
BPF not responding to Tube thoracostomy
Bronchostenosis
To rule out Ca
Trapped Lung (PTB with Pleural effusion)
Destroyed lung with Recurrent Haemoptysis & Infection
1) What Is The Role Of Surgery In TB Lung?
Ans: Surgery for pulmonary tuberculosis (PTB) having been the treatment of choice in the past. It has now been relegated to second place for treatment of this disease.
2) What Are The Indications For Surgery?
Ans: Important indications are
a) the complications of PTB, among which bronchiectases with suppuration, superinfections, or hemoptysis are found,
b) A destructive pulmonary sequelae such as destroyed lung,
c) Massive hemoptysis not controlled by non surgical methods.
d) Presence of a bronchopleural fistula that cannot be resolved with pleural drainage.
e) The existence of an unidentifiable pulmonary mass or node is a surgical criterion.
f) A pulmonary aspergilloma or fungal ball in lung cavity.
3) What Are The Newer Indications For TB Lung Surgery?
Ans: A resurgence of the role of surgery in managing TB due to the overall increase in global incidence, and the emergence of multidrug-resistant TB (MDR-TB, resistance to both Isoniazid and the Rifampicin) or extensive drug-resistant TB (XDR TB, resistance to Rifampin and Isoniazid, to fluoroquinolones and at least one of the following injectable anti-TB drugs: capreomycin, Kanamycin, or Amikacin)
4) What Are The Types Of Operation?
Ans: The following are the types of operation currently performed as mentioned in World Health Organisations book:
a) lung resections of different size:• – wedge resection – segmentectomy
– lobectomy and bilobectomy – combined resection (lobectomy plus minor resection)
– pneumonectomy or pleuropneumonectomy
– lung resections with different correction methods of the haemithorax’s volume;
b) extrapleural thoracoplasty;• extrapleural pneumolysis;• thoracomyoplasty;• pleurectomy and decortications of the lung;•
c) operations on the bronchi:• – occlusion – resection – bronchoplasty – re-amputation of the stump
5) What Are The Conditions & Timing For Surgery?
Ans: Proper patient selection and the timing of operations are crucial to avoid relapses and to provide a higher chance of cure. Good cooperation between treating physicians and thoracic surgeons, as well as patients’ adherence to pre- and postoperative intervention Anti TB drugs.(WHO Paper)
