IJTCVS Dewan et al 15 2006; 22: 15–18 Resistant tuberculosis Surgical interventions in multidrug-resistant tuberculosis : Retrospective analysis of 74 patients treated at a tertiary level care centre Ravindra Kumar Dewan M.Ch., Himanshu Pratap MS LRS Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi Address for correspondence: Dr. Himanshu Pratap Senior Resident, Thoracic Surgery, L.R.S. Institute of T.B. & R.D. Sri Aurobindo Marg, Mehrauli, New Delhi-30. E-mail: drhpratap@yahoo.com © IJTCVS 097091342210305/64 Received - 18/09/05; Review Completed - 30/09/05; Accepted - 02/12/05. Introduction From beginning as Collapse therapy 1 to becoming superfluous in the post streptomycin era, surgery in tuberculosis has tended to have come the proverbial full- circle in the wake of multidrug-resistant tuberculosis (MDR-TB). MDR-TB, defined as tuberculosis showing resistance to ,at least, Isoniazide and Rifampicin irrespective of resistance to other drugs is a serious threat to tuberculosis control world-wide. Current prevalence rate of MDR-TB in India, in newly Abstract Background: Multidrug-resistant tuberculosis is a serious threat to tuberculosis control world wide with ominous implications in Indian context. The medical treatment of this disease is expensive, toxic and, most unfortunately, far from satisfactory. In carefully selected cases adjuvant surgery plays very significant role in achieving bacteriological cure. Methods: Retrospective analysis was done in 74 cases of multidrug-resistant tuberculosis, in whom some surgical interventions were carried out at L.R.S. Institute of Tuberculosis and Respiratory Diseases New Delhi between the years 1999 to 2003. There were 52 male and 22 female patients in the age group of 24 to 40 years. All were sputum positive at the time of surgery. Majority of patients were treated with pulmonary resections (Pneumonectomy [n = 37], Bilobectomy [n =09] and Lobectomy [n = 21] ), while Primary Thoracoplasty with Apicolysis was planned in 7 patients. Post operatively 2 nd line anti tubercular chemotherapy was prescribed for 24 months. Results: There were 03 early and 02 late deaths. Postoperative complications were seen in 24 cases. Eight patients developed bronchopleural fistula with empyema. At a mean follow-up of 2.8 years bacteriological cure was achieved in 62 patients Conclusion: Judiciously performed adjuvant surgery can yield excellent long term bacteriological cure with acceptable mortality and morbidity in multidrug-resistant tuberculosis. Morbidity and drug compliance remain as problem areas. (Ind J Thorac Cardiovas Surg 2006; 22: 15–18) Key words: Multidrug-resistant-Tuberculosis, Pulmonary resection, Thoracoplasty diagnosed cases, is about 3.4% or less 2 , and is much higher in patients already treated for tuberculosis, and hence constitutes a serious public health concern. Commonest risk factor for the development of MDR- TB is a previous exposure to anti-tuberculous therapy (ATT) and of late, Human Immunodeficiency Virus (HIV) infection has emerged as an important predisposing factor 2,3 . The medical treatment for MDR-TB is prolonged, toxic and suboptimal with predicted success rate of less than 50% vis-à-vis over 90% success for drug - susceptible strains 2-4 . Increasingly, since the last decade in particular, surgical interventions are being employed in the overall management of MDR-TB, with good results 5-8 . Here is a report of our experience with surgical interventions in cases of MDR-TB, carried out at our tertiary level health care centre. 064-05.p65 2/17/2006, 1:51 PM 15