Pneumonectomy for tuberculosis.

OBJECTIVE

Surgery for tuberculosis has been of major concern because of its associated morbidity and mortality, particularly with respect to pneumonectomy.

METHODS

Over a period of 11 years, between January 1985 and December 1995, pneumonectomy was performed for 20 patients with documented history of mycobacterium tuberculosis (TB). There were 12 male and eight female patients with an average age of 28.7 years. All patients had productive cough for an average duration of 12.8 years, while ten (50%) had an additional hemoptysis for an average duration of 3.9 years. Four patients (20%) were still with positive acid-fast bacilli due to drug resistance and four (20%) had aspergilloma complex. Preoperatively, all patients showed radiological evidence of unilateral destroyed lung with no perfusion.

RESULTS

Among the 20 patients with post-tuberculosis lung destruction, 16 had left lung destruction and four had the right lung destroyed. In this series, there was no mortality and morbidity accounted for 15% (n = 3). Two patients required re-exploration for bleeding, while one patient developed post-pneumonectomy empyema without bronchopleural fistula, for which drainage with rib resection was performed. All patients were found to be symptom free during the follow up period which averaged 93.7 +/- 23.9 months (range between 12 and 124 months).

CONCLUSIONS

In this series of 20 patients, pneumonectomy for TB and post-tuberculosis lung destruction was performed with no mortality and acceptable morbidity. Meticulous surgical technique is mandatory to avoid operative complications. Persistent positive sputum for acid-fast bacilli should not be considered as contraindication in symptomatic patients.