Surgical Strategies in the Management of Thoracic Tuberculosis: Over 12 Years experience

<bold>Introduction:</bold> Medical treatment remains the primary approach for tuberculosis, and surgery is reserved for multidrug resistance, diagnostic challenges, and complications. We aimed to investigate the epidemiological profiles of operated patients for thoracic tuberculosis (TT), to identify surgical indications and procedures, and to evaluate outcomes. <bold>Methods:</bold> This was a retrospective study including all patients operated for TT in our department from January 2011 to February 2023 <bold>Results:</bold> We included 36 cases (2% of all thoracic surgery activity), predominantly males (61%), with a mean age of 47 years. Chest x-ray revealed solitary pulmonary nodules (41.7%) and pleural effusions (41.7%). CT scans were conducted for all patients. Biopsies were performed in 36.1% of cases, highlighting granulomas with caseous necrosis (50%) and aspergillosis (8.3%). Surgical indications were diagnostic for mediastinal adenopathy (16.7%) and parietal masses (13.9%), treatment of TT complications (cold parietal abscess (13.9%), hemoptysis (11.1%), pneumothorax (5.6%) and pleural empyema (8.3%)). Surgical approaches encompassed thoracotomy (38.9%), mediastinoscopy (16.7%), video-thoracoscopy (19.4%), and elective incisions (25%). Lung resections included lobectomies (11.1%), pneumonectomies (8.3%), and wedge resections (2.8%). Postoperative outcomes were favorable in 66.7% of cases. The mean complications were prolonged air leak (5.6%), respiratory failure (11.1%), wound infection (8.3%), and bleeding (8.3%). <bold>Conclusion:</bold> This study provides a comprehensive view of the surgical landscape for TT, highlighting the role of surgery in managing TT complications and emphasizes the need for a multidisciplinary approach.