Two-Stage Pleuropneumonectomy with Preoperative Transsternal Occlusion of the Main Bronchus in the Treatment of Advanced and Complicated Pulmonary Tuberculosis

Objective: To substantiate the surgical strategy developed by our team for multistage surgical treatment of advanced and complicated pulmonary tuberculosis. Materials and methods : The study included 62 patients who underwent surgery between 1987 and 2025 for advanced pulmonary tuberculosis complicated by empyema with bronchopleural fistula. This diagnosis was present in 57 (92%) patients. In 3 (4.8%) patients, the indication for surgery was chronic suppurative lung disease, and in 2 (3.2%) patients it was lung cancer complicated by secondary abscess formation and empyema with a bronchopleural fistula. Results: No intraoperative complications were observed at the stage of bronchopleural occlusion. Among significant postoperative complications, bronchial fistula recanalisation occurred in 1 (1.6%) patient and was successfully managed by prolonged sanation through a thoracostomy. The most frequent complication during pleuropneumonectomy was opening of cavitary lesions or the empyema cavity during pneumolysis, observed in 15 (24.5%) patients. No 30-day or 90-day mortality was recorded. Long-term outcomes were assessed in 59 (98%) patients. One-year mortality was 4 (6.4%) cases. Conclusion: The recommended surgical strategy and technique for the treatment of bilateral complicated pulmonary tuberculosis, including transsternal occlusion of the main bronchus and either single-stage or staged resections of the remaining lung combined with collapse surgery, enabled durable cure in more than 82% of patients who otherwise had an extremely poor prognosis without surgical intervention.

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