Surgical Trends in Pulmonary Tuberculosis

¹ Chief, Division of Thoracic Surgery, University of Oregon Medical School Hospitals and Clinics.

Like others, we have practically abandoned the use of artificial pneumothorax, phrenemphraxis and primary thoracoplasty in the treatment of pulmonary tuberculosis. Most of the patients on our service who do not manifest adequate resolution of their disease under medical management, become candidates for pulmonary resection, unilateral or bilateral.

Pulmonary resection is preferred to collapse therapy because:

1) It is considered to offer a more definitive and permanent means of control.

2) It is generally more conserving of respiratory function.

3) It avoids the late complications of artificial pneumothorax and extrapleural plombage.

4) It generally results in immediate sputum conversion.

5) Patients, usually, have a much shorter period of morbidity and can be rehabilitated earlier.

6) It permits a more rapid hospital turnover, reducing the bed shortage and permitting definitive treatment of a much larger number of patients during a specific period of time.

7) We believe that its wider use will materially reduce the number of readmissions due to reactivation and spread of disease.

8) Concomitantly there should be public health benefits if infectiousness is more readily and promptly controlled.

9) By reducing the length of therapy required for treating the individual patient the economic savings, to the patient and the State, should become of great magnitude.

I admit that we may be using resection therapy too widely. We may learn that the antimicrobial medications now available, and new ones which will doubtless be discovered, can obviate the need for much of the surgery which we now perform. I have tried to review the trends which the surgical treatment of pulmonary tuberculosis has shown in our hands and certainly in those of many others. We must, however, continually re-evaluate our position. I have not attempted to offer statistics concerning the results of treatment, feeling that they would not have much value, as yet, from the standpoints of numbers and of time. In another 10 years we may look back on this heyday of resection as we do now on that of pneumothorax therapy. For while time is said to heal all wounds, it must also wound all those who would continue to heal by the convictions of yesterday.