Outocme of Surgical Management of Multi-Drug Resistant Tuberculosis Peshawar Experience of 135 Cases over a period of 12 years

Abstract

Objective: To assess the results of surgery for treatment failure Multidrug- Resistant Tuberculosis.Methods: Retrospective analysis was done in 135 cases of multi-drugresistant tuberculosis in whom surgical cure was attempted after being declared treatment failure by pulmonologist, at Department of Thoracicsurgery, Lady Reading Hospital, Peshawar, Pakistan between the years 2002 to 2014.Results: There were 81 male and 54 female patients in the age group of 14-54 years. All were sputum positive at the time of surgery. Majority of patients were treated with pulmonary resections (Pneumonectomy [n=31], bilobectomy [n=32] and lobectomy [n=60), while primary thoracoplasty with apicolysis was done in 12 patients. Post operatively 2nd line anti tubercular chemotherapy was prescribed for 24 months.Mortality was 6/135 (4.44%) and included four early deaths which included respiratory failure in three and myocardial infarction in one and two late death due to bronchopleural fistula with empyema. Morbidity was 14/135 (10.37%) and included seven patients who developed bronchopleural fistula with empyema, apical space in three patients and wound infection in four patients. At a mean follow-up of one year bacteriological cure (-ve Sputum microscopy& Culture) was achieved in 122 out of 129 alive patients (94.56%).Conclusion: Judiciously performed adjuvant surgery can yield excellent long term bacteriological cure with acceptable mortality and morbidity in treatment failure multidrug-resistant tuberculosis.