Pak J Med Sci 2008 Vol. 24 No. 3 www.pjms.com.pk 351 Original article SURGICAL INTERVENTIONS IN MULTIDRUG-RESISTANT TUBERCULOSIS: RETROSPECTIVE ANALYSIS OF 27 PATIENTS TREATED AT A TERTIARY LEVEL CARE CENTER Amer Bilal 1 , Abdul Baseer 2 , Mohammad Muslim 3 , Faridullah 4 , Arshad Javaid 5 , MZ Afridi 6 , MY Khan 7 Abstract Objective: To assess the results of surgery for Multidrug- Resistant Tuberculosis (MDR-TB). Met hodology: Retrospective analysis was done in 27 cases of multidrug- resistant tuberculosis in whom some surgical interventions were carried out at Department of Thoracic surgery, Lady Reading Hospital Peshawar between the years 2002 to 2007. There were 18 male and 9 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=07], bilobectomy [n=08] and lobectomy [n=10]), while primary thoracoplasty with apicolysis was done in two patients. Post operatively 2 nd line anti tubercular chemotherapy was prescribed for 24 months. Result s: There was one early and one late death. Postoperative complications were seen in three cases. One patient developed bronchopleural fistula with empyema. At a mean follow-up of one year bacteriological cure was achieved in 24 patients. Conclusion: Judiciously performed adj uvant 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. KEY WORDS: Multidrug resistant-tuberculosis, Pulmonary resection, Thoracoplasty. Pak J Med Sci April - June 2008 (Part-II) Vol. 24 No. 3 351-355 How to cite this article: Bilal A, Baseer A, Muslim M, Faridullah, Javaid A, Afridi MZ, et al. Surgical interventions in multidrug-resistant tuberculosis: retrospective analysis of 27 patients treated at a Tertiary Level Care Center. Pak J Med Sci 2008;24(3): 351-5. 1. Amer Bilal, 2. Abdul Baseer, 3. Mohammad Muslim, 4. Faridullah, 1-4: Dept. of Thoracic Surgery, PGMI, Lady Reading Hospital, Peshawar - Pakistan. 5. Arshad Javaid, 6. MZ Afridi, 7. MY Khan, 5-7: Pulmonology, PGMI, Peshawar - Pakistan. Correspondence Dr. Amer Bilal E-mail: aamirct@hotmail.com * Received for Publication: February 25, 2008 * Revision Received: April 25, 2008 * Revision Accepted: April 29, 2008 INTRODUCTION From starting as collapse therapy 1 to becom- ing 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 re- sistance to, at least, isoniazide and rifampicin irrespective of resistance to other drugs is a serious threat to tuberculosis control world- wide. The World Health Organization (WHO) estimates that 50 million people worldwide are already infected with drug-resistant tubercu- losis. 2,3 Countries and regions are named “hot spots” where MDR-TB makes up more than