SURGICAL INTERVENTIONS IN MULTIDRUG-RESISTANT TUBERCULOSIS: RETROSPECTIVE ANALYSIS OF 27 PATIENTS TREATED AT A TERTIARY LEVEL CARE CENTER

Background: Multidrug-resistant tuberculosis is a serious threat to tuberculosis control world wide with ominous implications in Indian context. The medical treatment of this disease is expensive, toxic and, most unfortunately, far from satisfactory. In carefully selected cases adjuvant surgery plays very significant role in achieving bacteriological cure. Methods: Retrospective analysis was done in 74 cases of multidrug-resistant tuberculosis, in whom some surgical interventions were carried out at L.R.S. Institute of Tuberculosis and Respiratory Diseases New Delhi between the years 1999 to 2003. There were 52 male and 22 female patients in the age group of 24 to 40 years. All were sputum positive at the time of surgery. Majority of patients were treated with pulmonary resections (Pneumonectomy [n = 37], Bilobectomy [n =09] and Lobectomy [n = 21] ), while Primary Thoracoplasty with Apicolysis was planned in 7 patients. Post operatively 2 nd line anti tubercular chemotherapy was prescribed for 24 months. Results: There were 03 early and 02 late deaths. Postoperative complications were seen in 24 cases. Eight patients developed bronchopleural fistula with empyema. At a mean follow-up of 2.8 years bacteriological cure was achieved in 62 patients Conclusion: Judiciously performed adjuvant surgery can yield excellent long term bacteriological cure with acceptable mortality and morbidity in multidrug-resistant tuberculosis. Morbidity and drug compliance remain as problem areas. (Ind J Thorac Cardiovas Surg 2006; 22: 15–18)