Median sternotomy for pneumonectomy in patients with pulmonary complications of tuberculosis

Background. Traditionally, a thoractomy incision is used for pulmonary complications of tuberculosis. An attractive alternative is being presented by the use of midline sternotomy in such patients, which is the aim of this study. Methods. Five patients (four male, one female) with pulmonary complications of tuberculosis requiring surgical therapy in 1993 and 1994 were treated through a median sternotomy. The median patient age at time of surgery was 40.2 years and the median patient follow-up was 4.0 years (range 1.0 to 5.0 years) in this retrospective review. Results. All patients had uncomplicated operative courses and were discharged from the hospital. One patient's in-hospital postoperative course was complicated by prolonged ventilator dependency requiring temporary tracheostomy; he died 1 year postoperatively after hospital discharge due to recurrent multidrug-resistant tuberculosis. Sternal wound infections and bronchopleural fistulas were not observed in any patients. Conclusions. Surgical treatment of pulmonary complications of tuberculosis was traditionally performed through a thoracotomy approach. Many patients with tuberculous lungs have pulmonary adhesions or intrathoracic scarring from previous surgery, which would require extrapleural resection. Bleeding was a frequent complication of this procedure. Sternotomy offers excellent exposure of the intrapericardial vessels, and reduced postoperative disability compared to the standard thoracotomy, which may be an advantage given that the majority of patients in this population have poor pulmonary function. We recommend median sternotomy as an alternative operative approach in selected patients with pulmonary complications of tuberculosis.