Tubercular tracheobronchial stenosis: When is surgery indicated?
Tracheobronchial stenosis is troublesome long-term sequelae of tracheobronchial tuberculosis (TBTB) which occurs due to fibrosis and consequent stricture formation. Mohan et al conducted a study at Sir GangaRam hospital, New Delhi to evaluate factors effecting surgical outcome in tracheobronchial stenosis.
TB can cause significant obstruction to the airways which results in recurrent infections, pulmonary function derangement and severe limitation of exercise capacity. Hence interventions such as bronchoscopic balloon dilatation, laser fulguration, and silicon stenting, can offer immediate symptomatic relief. Nevertheless, recurrence rate of stenosis after such methods is high for which repeated procedures may be required, hence surgery is considered when repeated interventions fail.
Researchers conducted a retrospective analysis of 20 operated cases of tubercular tracheobronchial stenosis. Left main bronchus (LMB) was the most commonly involved site with an incidence of 80% and the patients were predominantly females (80%). All the patients had invariably undergone balloon dilation with frequency ranging from one to seven.
Out of 16 cases (80%) with LMB involvement, 12 cases underwent lung preserving surgery and rest 4 required complete pneumonectomy in view of completely destroyed bronchiectatic lung. Postoperative complications occurred in five patients most common being prolonged air leak and surgical site infection. At followup none of the patients had recurrence of symptoms. Also FEV1 showed significant improvement in all 16 patients who underwent lung preserving surgery.
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