Tuberculosis surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Surgery is indicated in certain conditions such as drainage of abscesses and empyema, ventricular shunt in tubercular meningitis, surgical resection of damaged tissues in abdominal tuberculosis, stabilization of the spine in case of Pott’s disease ,pneumonectomy, lobectomy, pericardiocentesis or surgical repair of pericardium.
Surgery
Pulmonary tuberculosis
- Pneumonectomy, which is removal of one entire lung, is reserved as a last resort in serious cases of tuberculosis which are drug resistant. [1]
- Lobectomy, which is removal of lobes of lung, is in serious cases of multi-drug resistant tuberculosis if it has affected only a lobe or part of the lung.
- Surgery can be used to remove cold abscesses and tuberculous empyema.
- Segmentectomy or wedge resection is used in some cases of multi-drug resistant tuberculosis .
Renal tuberculosis
Surgery is required to manage the urinary obstruction in genito-urinary tuberculosis. The three most common locations that may cause urinary obstruction is as follows. [2]
- Pelvi-ureteral junction
- Calyx
- Lower end of the ureter
| Types of surgery | Proceedure |
|---|---|
| Cavernotomy | It involves removal of the caeseous material leading to prevention of complications like abscess rupture. It has excellent prognosis |
| Partial nephrectomy | This was an old technique to remove the affected tissue. Recently the drug therapy can help the calyx to heal, so partial nephrectomy is not widely done now. |
| Nephrectomy | Chief indication of nephrectomy is obstruction of pelvi-ureteric junction. Plastic surgery of pelvi uretric junction is an alternative to it. Drianage improves the treatment |
| Excision of stricture then re implantation of ureter into the bladder. | This is another conservative surgical procedure that has good prognosis. |
Spinal tuberculosis
- Biopsy is needed to reach a diagnosis.
- Gross instability and neurological complications can be managed by by decompression and fusion of the anterior segments.
- Arthrodesis is done for repairing the joint damage.
The cornerstone of treatment for skeletal tuberculosis is antibiotics and surgery. Surgical treatment of spinal tuberculosis of different 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
The treatment of choice is surgical removal or repair of infected sac of pericardium if it is not responsive to antibiotics. The available surgical procedures include: Open surgical removal and pericardiocentesis. Pericardiectomy is used for patients who deteriorate even after 4-8 weeks of anti tuberculous treatment. [3]
Tuberculosis meningitis
Surgical placement of shunt is used to drain the fluid and prevent the brain damage as a result of accumulation of fluid.
Abdominal tuberculosis
Surgical resection of intestine that is damaged by tuberculosis and not responding to anti tuberculous treatment can prevent the complications of abdominal tuberculosis
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.
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