Post-Tuberculous Bronchiectasis

Indications for Surgical Treatment

NEAL C. HAMEL, M.D., JOHN N. BRIGGS. M.D., and

THOMAS A. SCHULKINS. M.D., Encino

PULMONARY RESECTION is firmly established as the * Two hundred twelve of 308 post-tuberculous
most effective treatment for patients with symptoma- patients were found to have significant bron-
tic bronchiectasis. In the present study, dealing with chiectasis; and in 105 of them, in whom certain
symptoms or combinations of symptoms and
post-tuberculous patients who were examined to conditions were observed, resectional opera-
determine whether or not they had bronchiectasis, tions were carried out. Good results were ob-
the main emphasis is on the indications for resec- tained in 81 per cent of the group. There were
tional operations. serious complications in 13 per cent. Three of
the patients died, two after pneumonectomy, one
Significant bronchiectasis was demonstrated in after lobectomy plus segmental excision.
212 of 308 post-tuberculous patients who were
bronchoscopically and bronchographically examined
in the years 1955-1959. Pulmonary resectional op- chiectasis is not commonly used by the authors
erations were performed in 105 of them. because of higher incidence of morbidity than with
Post-tuberculous bronchiectasis is defined as cy- lobectomy. The relatively high incidence of pneu-
lindrical or sacular dilatation of the bronchial tree monectomy in this series was due to severe bron-
occurring in an area of previous tuberculosis. The chiectasis combined with atelectasis and fibrosis-a
extent of the previous tuberculosis does not always process that is commonly called "destroyed lung."
indicate the degree of post-tuberculous bronchi- Complications occurred in 19 per cent of cases,
ectasis. serious complications in 13 per cent (Table 3).
Indications for pulmonary resection in post-tuber- Good results were obtained in 81 per cent of the
culous bronchiectatic patients (Table 1) are as group. Two of the three deaths were associated with
follows: pneumonectomy. The remaining death was in a
1. Presence of symptoms: episodes of hemoptysis,
recurrent pneumonitis or occasional sputum posi- TABLE l.-IndIcatlons for Resectlonal Operation In Post-
tive for M. tuberculosis which cannot be explained Tuberculous Bronchlectasis
on any other basis: More than half of the patients 1. Symptomatic
in the present study who underwent operation were a. Bleeding
in this category. b. Recurrent pneumonitis
c. Occasional recurrent positive sputum
2. Bronchiectasis that is located in poor drainage 2. Inadequately drained
areas of the lungs, such as the lower lobe, the a. Lower lobe
middle lobe or the lingula. Many of these patients b. Middle lobe
c. Lingula, etc.
have the symptoms noted in the first category. 3. Co-existing with
3. Bronchiectasis co-existent with bronchosteno- a. Bronchostenosis
sis, atelectasis or large amounts of residual fibronod- b. Atelectasis
c. Large amounts of residual fibronodular disease
ular disease. 4. In the occasional young patient in whom it is the only
4. Bronchiectasis in a young patient in whom it post-tuberculous residual
is the only post-tuberculous residual. This group is
rather small and the condition represents a relative TABLE 2.-Types of Resectlonal Operation In 105 Cases of
Post-Tuberculous Bronchlectasls
indication for resectional operation.
The kinds of operation and the numbers of cases 1. Lobectomy ....... 42
in which they were done in the present series are 2. Pneumonectomy ....... 36
shown in Table 2. Segmental resection for bron- 3. Lobectomy and segmnental ......................... 15
4. Segmental ................. 4
5. Multiple segmentals 6
Submitted March 23, 1962. 6. Bilateral resections ... 2
VOL. 97, NO. 4 * OCTOBER 1962 233
TABLE 3.-Compllcations In 105 Resections for Post-Tuberculous
Bronchlectasis
ventable by better preoperative evaluation and in-
tensive pulmonary studies when indicated. Cardiac
Deaths* ... .......3 catheterization has proven to be an aid in some of
Broncho-pleural fistulae the more difficult preoperative decisions.
Temporary
a. -2....... 2
b. Prolonged* ....... -3..... 3
Empyema* ...................3.............3 DISCUSSION
Respiratory insufficiency*......................5............5
Hemothorax --------------2 Post-tuberculous bronchiectasis is relatively com-
Wound infection ............. - ..1 mon in patients who have had recurring tubercu-_
Postoperative pneumonia -1......1 losis. The mere presence of the condition is not a
SUMMARY OF RESULTS: direct indication for operation, but careful evalua-
Total complications ............... - ..... 20 (19%) tion of these patients reveals a relatively high
Serious complications .... 14 (13%o)
Good results ---------------------------- 85 (81%o) incidence of symptoms associated with it. These
Serious results are marked with an asterisk. symptoms include hemoptysis, recurring pneumoni-
tis and, at times, sputum persistently positive for M.
tuberculosis. Bronchiectasis is often associated with
patient who had lobectomy plus segmental excision, bronchostenosis, atelectasis and large amounts of
a resectional combination which in the authors' residual fibronodular disease. When bronchiectasis
experience is associated with a relatively high mor- is located in poor drainage areas such as the lower
bidity rate. When the original disease extends well lobe, the middle lobe or the lingula, resectional
beyond the confines of a lobe, we often recommend operation may be indicated. Surgical excision may
a pre-resection thoracoplasty to help avoid the mor- be recommended for younger patients in whom mod-
bidity associated with resection which includes more erate to pronounced bronchiectasis remains as the
than a lobe. Postoperative respiratory insufficiency only visible residual of a previous tuberculous
was noted in five patients. We are devoting more process.
attention to this complication which is largely pre- 16100 Ventura Boulevard, Encino (Hamel).

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