title: Surgery and tuberculosis.
abstract: OBJECTIVE
  Tuberculosis (TB) remains a global emergency and continues to kill 1.7 million people globally each year. In the UK, figures for TB are increasing especially in urban areas. There have been advances in imaging techniques as well as increasingly invasive medical interventions in both the diagnosis and treatment of this complex disease. Surgery continues to play an evolving and more challenging role in TB management as minimally invasive procedures can be increasingly used in diagnosis and treatment. Open surgical procedures continue to prove an important adjunct in the management of multidrug-resistant TB (MDR-TB) and the complications of TB.
  
  
  RESULTS
  Since the peak of surgical treatment for TB in the 1950s, surgery is currently mainly reserved for 'difficult-to-diagnose' or indeed 'difficult-to-treat' cases of TB. Improved diagnostics, medical imaging and invasive medical interventions have all enabled alternatives to early surgical intervention. As improving minimally invasive surgical techniques provide diagnostic and treatment options, older methods of surgically managing complex TB have been revisited. To date most of the studies are retrospective and observatory but large studies and meta-analyses are showing the continued role surgery has to play in the treatment of TB.
  
  
  CONCLUSIONS
  This review will focus on new diagnostic imaging techniques and medical interventions which may become increasingly available in both developing countries and in the Western world. It will also highlight the continued role of minimally invasive video-assisted thoracoscopic surgery as well as open surgery in managing TB and MDR-TB.
authors.affiliation: The London Chest Hospital, and Department of Infectious Diseases, University College London Medical School, London, UK. i_g_cummings@hotmail.co.uk
authors.forename: Ian
authors.initials: I
authors.lastname: Cummings
authors.forename: Justin
authors.initials: J
authors.lastname: O'Grady
authors.forename: Vasudev
authors.initials: V
authors.lastname: Pai
authors.forename: Shyam
authors.initials: S
authors.lastname: Kolvekar
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
mesh_terms: D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008481:Mediastinoscopy; D009169:Mycobacterium tuberculosis; D011859:Radiography; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000601:surgery*; D014463:Ultrasonography