Aamir Bilal, Abdul Baseer, Muhammad Imran.
Outcome of Surgical Management of Multidrug Resistant Tuberculosis Peshawar Experience of 135 Cases Over a Period of 12 Years.
Pak J Chest Med Jan ;23(1):15-9.

Objective: To assess the results of surgery for treatment failure MultidrugResistant Tuberculosis. Methods: Retrospective analysis was done in 135 cases of multidrugresistant tuberculosis in whom surgical cure was attempted after being declared treatment failure by pulmonologist, at Department of Thoracic surgery, 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.

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