Tuberculosis surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Surgery can be indicated, particularly to drain abscesses , empyema, venticular shunt in tubercular meningitis, surgical resection of tissues affected in abdominal tuberculosis, stabilize the spine in case of Pott's disease , lobectomy, pneumonectomy, pericardiocentesis or surgical repair of pericardium.
Surgery
Pulmonary tuberculosis
- Pneumonectomy or removal of one entire lung is reserved as a treatment option for serious conditions of tuberculosis which are drug resistant. [1]
- Lobectomy or removal of lobes of lung are used to treat drug resistant tuberculosis if it has affected only a part of lung.
- Surgery may be necessary to remove cold abscesses and tuberculous empyema.
- Segmentectomy or wedge resection is used in certain cases for treating tuberculosis resistant to anti tubercular drugs.
Renal tuberculosis
Surgery is necessary to manage the urinary obstruction in genito urinary tuberculosis. 3 most common sites which can cause urinary obstruction is as follows. [2]
- Pelvi- ureteral junction
- Calyx
- Lower end of ureter
| Types of surgery | Proceedure |
|---|---|
| Cavernotomy | It involves removal of avascular caeseous material which helps in preventing complications like abscess rupture. It has got excellent prognosis |
| Partial nephrectomy | This was an old technique to remove the affected tissue. Recently the drug regimen helps to heal the calyx and hence partial nephrectomy is not widely practised now. |
| Nephrectomy | Chief indication of nephrectomy is obstruction of pelvi-ureteric junction. Plastic surgery of pelvi uretric junction is also an option for it. Drianage improves the treatment |
| Excision of stricture and re implantation of ureter into the bladder. | This is another conservative surgical management which has shown promising results. |
Spinal tuberculosis
- Biopsy is used to make a diagnosis.
- Gross instability and neurological complications are treated by decompression and fusion of the anterior segments.
- Joint damage may be repaired by late surgery and arthrodosis.
The main stay of treatment for skeletal tuberculosis is antibiotics and surgery. Surgical management of tuberculosis of spine of various stages are given below. [1]
| Stage | Treatment |
|---|---|
| Stage 1 (synovitis) | Chemotherapy Rest Restriction of movements Splinting |
| Stage 2 (Early arthritis) | Chemotherapy Rest Restriction of movements Splinting Synovectomy |
| Stage 3 (Advanced arthritis) | Chemotherapy Osteotomy Arthrodesis Arthroplasty |
| Stage 4 (Advanced arthritis) | Chemotherapy Osteotomy Arthrodesis Arthroplasty |
| Stage 5 | Chemotherapy Osteotomybr> Arthrodesis Arthroplasty |
Tuberculosis pericarditis
Surgical removal or repair of infected sac of pericardium is often the treatment of choice if it is not responding to antibiotics. There are two different types of surgical procedures: Open surgical removal and pericardiocentesis. Pericardiectomy is reserved for patients who worsen even after 4-8 weeks of anti tuberculous therapy. [3]
Tuberculosis meningitis
Surgical placement of shunt is used to drain the fluid and prevent the damage to the brain caused by a build-up of fluid.
Abdominal tuberculosis
Surgical resection of intestine affected by tuberculosis which is not responding to multidrug regimen helps in preventing complications of abdominal tuberculosis
Surgical interventions in patients with MDR-TB
In patients with RR-TB or MDR-TB patients, elective partial lung resection (lobectomy or wedge resection) may be used alongside a recommended MDR-TB regimen (conditional recommendation, very low certainty in the evidence).
References
- ↑ 1.0 1.1 "Surgery tuberculosis" (PDF).
- ↑ HANLEY HG (1963). "TREATMENT OF RENAL TUBERCULOSIS". Br Med J. 2 (5373): 1611–2. PMC 1873944. PMID 14066180.
- ↑ Bozbuga N, Erentug V, Eren E, Erdogan HB, Kirali K, Antal A; et al. (2003). "Pericardiectomy for chronic constrictive tuberculous pericarditis: risks and predictors of survival". Tex Heart Inst J. 30 (3): 180–5. PMC 197314. PMID 12959199.