Surgical Treatment of Pulmonary Tuberculosis

1. Surgical Treatment of Pulmonary Tuberculosis By Dr. Khaled M. Abdel Aal MD Cardiothoracic surgery Sohag University

2. Pulmonary Tuberculosis • Definition: Pulmonary tuberculosis (TB) is a contagious bacterial infection that mainly involves the lungs, but may spread to other organs • Causes:     PT is caused by the bacteria Mycobacterium tuberculosis

3. Most people who develop symptoms of a TB infection first became infected in the past. • However, in some cases, the disease may become active within weeks after the primary infection.

4. The following people are at higher risk for active TB: 1. Elderly 2. Infants 3. People with weakened immune systems, e.g AIDS, chemotherapy, or immunosuppressive drugs.

5. Risk of contracting TB increases in • frequent contact with people who have the disease • poor nutrition • crowded or unsanitary living conditions

6. Symptoms • Cough (sometimes producing phlegm) • Coughing up blood • Excessive sweating, especially at night • Fatigue • Fever • Unintentional weight loss Other symptoms that may occur with this disease: • Breathing difficulty • Chest pain • Wheezing

7. Signs Examination may show: • Clubbing of the fingers or toes (in people with advanced disease) • Enlarged or tender lymph nodes in the neck or other areas • Fluid around a lung • Unusual breath sounds (crackles)

8. Surgical Treatment of Pulmonary Tuberculosis • The history of tuberculosis is long and vast • Surgery for pulmonary tuberculosis (PTB) has passed through various stages throughout history . • having been the treatment of choice in the past. • It has now been relegated to second place for treatment of this disease.

9. History of TB treatment 1. In the early it was just sanitarium isolation 2. surgery (collapse therapy eg, therapeutic pneumothorax, thoracoplasty, plombage and phrenictomy) 3. Later surgical resection was begun 4. The beginning of chemotherapy era in 1940 became a revolution, and the disease become controllable with drug treatment which now cures almost all patients with PTB 5. In the last decades there is serious spread of the disease. This increase is linked to the increase of patients with (AIDS), and other immunity - depressed populations.

10. Indications of surgery for pulmonary TB

11. Indications of surgery for pulmonary TB 1. Failure of medical treatment: ---cavity with persistant positive sputum Resistant strains MDR - TB XDR – TB Atypical organisms M. cansasii M. avium

12. Indications of surgery for pulmonary TB • 2. post TB residual lesions: a. post TB destroyed lobe: lobectomy b. post TB destroyed lung: pneumonectomy provided that the other lung is healthy by : clinically: no abnormal finding radiologically: no abnormal findings pulmonary function tests

13. Indications of surgery for pulmonary TB 3. tuberculoma: to a. exclude malignancy b. difficult or resistant to medical treatment

14. Indications of surgery for pulmonary TB • 4. complications: a. bronchiectasis: if it is localized to a segment, lobe or lung--------resection b. bronchostenosis-------------resection c. sever hemoptysis d. bronchopleural fistula

15. Indications of surgery for pulmonary TB 5. TB chronic sinus: excision 6. TB osteomylitis; complete rib excision with its periostium 7. pott’s abscess: -- drainage -- spine reconstruction

16. Indications of surgery for pulmonary TB 8. tuberculous empyema: a. acute: no chest tube unless respiratory compromise. b. Chronic (trapped lung): decortication

17. Indications of surgery for pulmonary TB 9. pericarditis: -- acute: with or without tamponade . Pericardial window -- chronic: constrictive pericarditis . pericardiectomy

18. Indications of surgery for pulmonary TB 10. post TB mediastinitis causing mediastinal fibrosis: surgery for releasing any surgical band compressing the tracheaa or bronchus. 11.Clinical picture of multidrug resistance with the focus of pulmonary tuberculous activity located in a segment, lobe, or lung. In these cases good results have described with surgical excision.

23. Thank you