Results of extrapleural thoracoplasty using minimally invasive technologies in the treatment of destructive pulmonary tuberculosis in HIV patients

The results of extrapleural thoracoplasty surgery (classical and using VATS – Video-Assisted Thoracoscopic Surgery) for destructive pulmonary tuberculosis in HIV patients (the main group consisted of 55 patients) were retrospectively analyzed. The data of destructive tuberculosis patients with HIV-negative status (57 patients) are presented as a control group, both groups are comparable in age and gender composition. VATS extrapleural thoracoplasty was performed noticeably in 25 % of patients in both groups – 12 (21.8 %) patients with destructive tuberculosis combined with HIV and 16 (28.1 %) patients without HIV infection. The volume and duration of the operation, blood loss, postoperative drainage, drainage-discharge, postoperative pain syndrome, and the progression of dyspnea were taken into account. An analysis of complications (intra- and postoperative) was performed. The terms of elimination (reduction by more than 2/3) of the cavity of destruction, resorption of foci of seeding, cessation (reduction in intensity) of bacterial excretion were estimated. HIV-Tuberculosis co-infected patients had a statistically significant more body weight deficit, were less married and had a permanent job. Drug addiction is common among this contingent, which caused frequent interruptions from treatment, with the development of XDR MBT. These patients were found to have a high incidence of chronic viral hepatitis and immunodeficiency. Data were obtained showing that the results of extrapleural thoracoplasty in both groups did not differ significantly. Complications were similar in frequency in both groups, were temporary, and remediable without the use of anesthesia; there were no deaths. VATS surgery reduced intraoperative complications. With continued anti-tuberculosis therapy after extrapleural thoracoplasty, a reduction in cavities was noted in 25 patients (45.5 %) one month after surgery and complete closure in 36 patients (65.5 %) 36 months after surgery. A decrease in bacterial excretion occurred in 35 patients (58.2 %), and 24 patients (43.6 %) were cleared of bacteria within the same timeframe. Extrapleural thoracoplasty doesn’t aggravate the course of HIV.

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