Indications and Outcome of Surgery in Pleuro-pulmonary Tuberculosis

Background: With the rising incidence of tuberculosis in our country that also faces serious challenges with poverty and human immune-deficiency virus infection, we experience a rise in the referrals for surgical intervention in patients with Pleuropulmonary tuberculosis. Aim: To study the indications and outcome of surgery in our pleuropulmonary tuberculosis patients. Methods: Pleuropulmonary tuberculosis patients who needed surgical intervention(s) for their disease in the cardiothoracic surgery unit of the University of Uyo Teaching Hospital over a 24-month period were retrospectively studied. Data on demographic characteristics, socio economic parameters, clinical presentation, radiological/ investigation findings, diagnosis, treatment and outcome were collated and analysed. Results: One hundred and fifty-six patients with pleuropulmonary tuberculosis were diagnosed and treated by the Directly Observed Therapy Unit of the Hospital during the study period, and 33 (21.2%) of them indications for surgical treatment. The patients consisted of 19 males and 14 females (M:F=1.3:1) with age range 2-68 years and mean 36.3 years. Seven indications of surgery in pleuropulmonary tuberculosis were encountered including symptomatic pleural effusion in 39.4%, broncho-pleural fistula (secondary spontaneous pneumothorax) in 21%, empyema thoracis in 12%, emphysematous bulla (9.1%), lung abscess (6.1%), haemoptysis (9.1%), and a case of destroyed lung syndrome (3.0%) The indicated surgical interventions included closed tube thoracostomy drainage (69.7%), Monaldi tube decompression (9.1%), and thoracotomy and decortication (3.0%). Mortality rate in this series was 3.0%. Conclusion: Surgery is indicated about 21% of our patients with pleuropulmonary tuberculosis with a mortality of 3.0% and we recommend a high index of suspicion, contact tracing and strict adherence to the modus operandi of directly observed continuous combined anti-tuberculous chemotherapy for pleuropulmonary tuberculosis.