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Role of Surgery in Management of Tuberculosis

Added on 01 Jun 2015
Last updated on 10 Jun 2015

Authors: By Masoud Dara, MD and Sudip Bhandari

In an era of increasing rates of drug resistant tuberculosis and lack of fully effective medicines, the role of surgery in the management of tuberculosis is being revisited. During a one-week virtual panel discussion organized in the GHDonline MDR-TB community, leading experts and community members presented their experiences and discussed when patients appear to benefit most from surgical interventions. Other topics included the benefits and risks of surgical interventions, how to mitigate these risks, the process of combining medical and surgical treatment, types of surgical interventions recommended, the requirements for successful outcomes of surgical intervention, and strategies for establishing best practices for the use of surgery.

Key points

  • Careful selection of candidates for surgical intervention is extremely important. Patients with localized disease affecting only a part of the lung tissues may benefit most from surgical interventions in conjunction with chemotherapy. Surgery can also be useful in life-threatening situations and in M/XDR-TB with unilateral involvement, but persistent smear or culture positivity despite drug treatment.
  • The risk and benefits of surgical operation should be assessed on a case-by-case basis. In the absence of new medicines and novel treatment regimens, surgery can play an important role in the management of some cases of tuberculosis in combination with medical treatment.
  • Benefits of surgery include the prevention of complications and recurrences of TB, readjustment of the bronchi and cavities, termination or reduction of bacterial excretion, etc. Risks include blood loss, anemia, development of bronchi-pleural fistulas, and infections.
  • Surgical operations can be conducted to manage an acute condition like severe hemoptysis or if the chance of medical treatment is low and the patient’s general condition permits operation.
  • It is important to note that in addition to surgical intervention, medical treatment shall also be continued until the patient is fully cured.
  • There are a wide variety of eligibility criteria and practices for surgery around the world because of the differences in outcome and the rate of relapses. Additionally, surgery also depends on the availability of resources and of experienced surgeons.
  • More research is needed to establish best practices in this field. For instance, there are controversies surrounding surgical treatment for tuberculomas and persistent cavity lesions with negative sputum on MDR-TB.
Key References