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Tuberculosis & Its Complications

An ailment that can be treated but requires surgical skills in situations where medicine fails.

Tuberculosis (TB) continues to be one of the most important infectious illnesses in India and the world in general. Although a majority of the cases are cured with anti-tubercular medicines, there is a significant percentage of cases that develop complications, such as destroyed lung, drug resistance, massive haemoptysis, or empyema, that are treated and cured by surgery.

What is Tuberculosis?

Mycobacterium tuberculosis is the bacterium that causes tuberculosis, which is mostly found in the lungs (pulmonary TB), but it can also infect any organ in the body. It is transmitted in the air as an infected individual sneezes, coughs, and speaks. The TB cases in India are the highest worldwide and have become a national health concern and a disease that all chest surgeons must know.

The disease occurs in stages: primary infection and latent TB, active disease, and disseminated disease. The bacteria are first contained in the immune system of the body in a majority of the patients, though they may be reactivated several years later, particularly in cases of malnutrition, diabetes, HIV, or immunosuppressive therapy.

How Does TB Affect the Lung?

The characteristic of pulmonary TB is the creation of granulomas, which are complexes of immune cells that are trying to wall off the bacteria. These granulomas can liquefy (caseous necrosis) as infection progresses, and this results in cavities in the lung. Cavities are very infectious as they contain millions of bacteria and have a connection with the airways.

In a disease that is not treated or allowed to be treated over a long period of time, large parts of the lungs are destroyed. Functional lung parenchyma is replaced by fibrosis and scarring. In more serious instances, specifically in a whole region of the lobe or lung, the tissue may turn into a dysfunctional, fibrotic, and bronchiectatic mass, a phenomenon known as destroyed lung. This causes chronic shortness of breath, frequent infections, and frequent breathing up of blood in such patients.

Surgical Complications of TB

Massive Haemoptysis

Coughing of blood, which is life-threatening, is usually due to Rasmussen (erosion of a wall of a pulmonary artery close to a hole) or tormented bronchial collateral vessels. Needs an urgent bronchoscopy, angioembolization, or emergency surgery.

Tuberculous Empyema

A collection of pus in the pleural space, which has TB. It is often connected with bronchopleural fistula (an abnormal communication of the lung and the chest cavity). Needs to be drained, decorticated, and even more complicated.

Destroyed Lung

Total or partial destruction of a lung through a chronic case of TB. The chronic infection, frequent coughing up of blood, and gradual dyspnea are such factors that surgical removal (pneumonectomy) is required, even though it is very risky.

Drug-Resistant TB (MDR/XDR TB)

In a situation where TB bacteria have developed resistance against the first and second line drugs, surgery could represent the sole opportunity for therapy by eliminating the main focus of the resistant organisms, together with the most appropriate medical therapy.

Other Complications

A common late complication is Aspergilloma, a fungal ball growing within an already existing TB cavity, and it is addressed separately. Other significant sequelae include bronchostenosis (airway constriction due to scar tissue), trapped lung, chronic pericardial constriction, and vertebral TB (Pott’s disease) with cord compression. TB of the lymph nodes in the mediastinum might squeeze airways and great vessels, and in some cases, it may need surgical debridement.

When is Surgery Indicated in TB?

Surgery is not the first line of TB, it is a well-considered treatment of certain well-characterized complications. Signs are immense or frequent haemoptysis, MDR/XDR TB limited to a single region of the lung, destroyed lung syndrome, bronchopleural fistula with tuberculous empyema, diagnostic uncertainty (excluding cancer), and incomplete cavitary disease despite adequate medical treatment.

What to Expect: Surgical Approach

TB complications surgery, lobectomy (removal of a lobe of one lung), pneumonectomy (removal of an entire lung), decortication (peeling of thickened pleural rind of a trapped lung), or thoracoplasty is one of the thoracic surgical operations that are the most technically challenging to perform. The disfigurement of the anatomy, heavy adhesions, and the low quality of the tissues pose their own challenges. Surgical technique, meticulous and careful preoperative optimization, and nutritional support are all vital to safe outcomes.

The use of modern minimally invasive methods (VATS, video-assisted thoracoscopic surgery) is determined by selective use in the case of early or less complex TB surgery, whereas open surgery is the rule in the case of complex, fibrotic, and adherent disease.

Post-Operative Recovery

TB surgery needs to be followed by the continuation of anti-tuberculous medications over the entire duration of the prescription, respiratory exercises, nutritional restoration, and follow-ups. Patients successfully undergoing surgery show a major change in their quality of life, as they are not afflicted with chronic cough, haemoptysis, and recurring infections. The aim is always the cure and the maintenance of the optimal lung function.

Consult Dr. Amol Bhanushali

In case you or a family member is diagnosed with complicated tuberculosis, destroyed lung, or drug-resistant TB and requires expert surgical opinion, Dr. Bhanushali provides full-scale evaluation and treatment.

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+91-9920024001

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What our patients say?

★★★★☆
I had an excellent experience with Dr. Amol Bhanushali for my brother's treatment. His approach to the diagnosis and treatment was very reassuring which every patient and his/her family expect. I am thankful to ...
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Vijay Kumar
★★★★☆
I had an excellent experience with Dr. Amol Bhanushali for my brother's treatment. His approach to the diagnosis and treatment was very reassuring which every patient and his/her family expect. I am thankful to him and the entire team at the Hospital.
Vijay Kumar
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I was admitted this month in Bhanushali Hospital. The nursing staff is very caring and support staff is very prompt. I received very good care from the doctors and the overall experience was excellent. The ...
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Sindhu Kadam
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I was admitted this month in Bhanushali Hospital. The nursing staff is very caring and support staff is very prompt. I received very good care from the doctors and the overall experience was excellent. The room was very spacious and was clean and tidy. Food provided is also nice with option for family members to buy as well.
Sindhu Kadam
★★★★☆
One of the oldest and best hospitals of Thane. The staff are polite and helpful. You are informed well in advance if there is any change in the appointment timings. Doctors are good. They have ...
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Pradeep Kumar
★★★★☆
One of the oldest and best hospitals of Thane. The staff are polite and helpful. You are informed well in advance if there is any change in the appointment timings. Doctors are good. They have a systematic approach towards the treatment and recommend only those tests and medicines which are required. They make you absolutely comfortable and at ease. Charges are also reasonable. Overall a very satisfying experience.
Pradeep Kumar
★★★★★
My wife, Rekha Tejura, had been suffering from TB for the last couple of years. The infection was in her chest and abdomen both. During the treatment with anti-TB medicines,...
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Hemang Tejura
★★★★★
My wife, Rekha Tejura, had been suffering from TB for the last couple of years. The infection was in her chest and abdomen both. During the treatment with anti-TB medicines, abdominal infection decreased but chest infection continued to persist. One of her lungs got covered with a very thick layer of pus and that side lung started to fail. At that time, we decided to go for a different doctor and heard about Dr. Amol Bhanushali. We visited him immediately and started treatment. From the very first visit itself, Dr. Bhanushali responded positively and supported us. The surgery was performed successfully using the latest technology available and my wife’s lung was saved. After the operation, she was fit and fine. I am thankful to Dr. Bhanushali for treating my wife.
Hemang Tejura
★★★★★
My wife, Varsha Garwa, was unwellfor nearly 10 years. She used to a keep coughing a lot and her cough used to contain blood at times. The blood went on increasing...
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Rajesh Garwa
★★★★★
My wife, Varsha Garwa, was unwellfor nearly 10 years. She used to a keep coughing a lot and her cough used to contain blood at times. The blood went on increasing over the last few years. She had developed a fungal ball (aspergilloma) in a cavity in a part of her lung. She was treated by various doctors, however, nothing worked. By a stroke of luck, we came across Dr. Amol Bhanushali’s name. The treatment offered by Dr. Bhanushali was world class. He was very patient and polite. He explained to us everything about the disease and its treatment. He also instilled confidence in us that the surgery would be successful. The Center for Lung Surgery at Dr. Bhanushali Hospital has state-of-the-art infrastructure and has everything under one roof. My entire family is grateful to Dr. Bhanushali for treating my wife and ending her decade long misery.
Rajesh Garwa
★★★★★
My mother, Manjushree Patil, had been suffering from MDR-TB and was on anti-TB drugs for six years. She took treatment from different doctors but there was no respite. Through word of...
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Shweta Patil
★★★★★
My mother, Manjushree Patil, had been suffering from MDR-TB and was on anti-TB drugs for six years. She took treatment from different doctors but there was no respite. Through word of mouth, we came to know about Dr. Amol Bhanushali. During our very first meeting with Dr. Bhanushali, he gave us detailed information about the disease and told us about the treatment. My mother’s left lung was completely destroyed by TB, and the other side was beginning to get affected too, so surgery was needed immediately. We were all very scared but Dr. Bhanushali and his team ensured that the surgery was successful and my mother got rid of TB and recovered completely. We are forever indebted to him for performing the surgery and bringing my mother out of the brink of death, thus giving her a new lease of life.
Shweta Patil