Extrapleural pneumonectomy for tuberculosis.

Tuberculosis has infected the human race for thousands of years. The best medical therapy in this country failed to eradicate the disease. In its current most virulent form it is drug resistant and will affect the practice of thoracic surgery once again. The most common indications for resection in patients with tuberculosis are drug resistance and localized disease. Pneumonectomy for tuberculosis, now necessary in more than 50% of operative cases, represents the highest risk operation. The risk is related directly to patient debilitation, the preoperative presence of positive sputum, and intraoperative contamination of the pleural space. Complications can be minimized and an acceptable mortality rate can be achieved with an extrapleural approach supplemented by muscle flap or omentum for reinforcement of the bronchial stump.