Objective: To report our experience of surgical intervention in Multi-Drug Resistant
Tuberculosis (MDR-TB).
Methods: During a 10 year period, fifty MDR-TB patients (26 men and 24 women) had
surgical intervention and underwent 54 pulmonary resections. All had a minimum of 4
months of medical therapy before operation and at the end of this period, the sputum was
positive. All had documented MDT-TB in-vitro studies in laboratories of Tabriz
University of Medical Sciences.
Results: Fifty patients underwent surgical operation. Four patients underwent eight
pulmonary resections. Nineteen patients (6 women and 13 men) had positive sputum at
the time of surgery. Pulmonary involvement was at left lung in 31 (62%) and at right lung
in 19 (38%) patients. Thirty seven patients (74%) had been on 4 drug regimen and 13
(26%) on 2 drug regimen in the past. Hemoptysis, total pulmonary destruction,
hydropneumothorax, bronchopleural fistula and positive sputum were the main causes of
referral for surgery. Thirty patients underwent lobectomy, 12 segmentectomy and 8
pneumonectomy. Operative mortality was 4% (2 patients). Significant morbidity was
2
14% (7 patients). After the operation, the sputum remained positive in 3 (6%) patients.
Mean length of follow-up was 3.5 years (4 to 80 months).
Conclusions: Surgery remains an important adjunct to medical therapy for MDR-MTB.
In the setting of localized diseases, persistent cavitary disease, lung or lobar destructions
or patient intolerance to medical therapy, surgical resection of the lung should be
undertaken. (Rawal Med J 2007;32:156-159).
Key words: Mycobacterium tuberculosis, multi-drug resistant tuberculosis, MDR-TB,
pulmonary resection.
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