Tuberculosis surgery
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Overview
Surgery may be necessary, especially to drain abscesses , empyema, venticular shunt in tubercular meningitis, stabilize the spine in case of Pott's disease , lobectomy, pneumonectomy and pericardioocentesis 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 can also be an option for removal of cold abscess and tuberculous empyema.
- Segmentectomy or wedge resection is used in some conditions for treating tuberculosis resistant to anti tubercular drugs.
Renal tuberculosis
Surgery is necessary to remove 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 rutputre. 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 |
| Excsion of stricture and reimplantation 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 instabillity 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 Osteotomy 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 proceedure. Open surgical removal and pericardiocentesis. Pericardiectomy is reserved for patients who deteriorates 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 brain caused by build up of fluid.
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.