Surgical management of airway obstruction in primary tuberculosis in children

Background. The role of surgery in the management of airway obstruction fro m lymphobronchial tuberculosis is discussed in the present article. Methods. Nine patients were operated on over a 4-year period and are curren tly presented. The age of the patients ranged between 5 and 28 months and 7 patients were male. Six patients required preoperative ventilation due to respiratory failure and all received standard posterolateral thoracotomies. Partial dissection and enucleation of bulky lymph nodes was performed in a ll but 1 patient. In that patient, the group of lymph nodes could be remove d fully, including the sheath. Results. All patients showed marked improvement and were weaned off the ven tilator between 24 and 72 hours postoperatively. Long term follow-up was av ailable in 7 patients and they are all doing well and are free of symptoms. Conclusions. Enucleation of mediastinal lymph nodes obstructing the airways in young patients with lmphobronchial tuberculosis is safe. It successfull y relieves obstruction and is devoid of complication providing that incisio n, evacuation, and curettage of lymph nodes is performed avoiding overzealo us dissection. (C) 1999 by The Society of Thoracic Surgeons.