The failed thoracoplasty.

Until a few years ago thoracoplasty was a final procedure in the treatment of pulmonary tuberculosis , and the introduction of the extra-fascial strip operation made the results of this operation appear very good. Thus Sellors (1947), reporting on 588 patients, all of whom were presumed to have a positive sputum before operation, records that 64% were doing full work and 6% light work, and, of 457 patients for whom the information was available, 84% were either sputum-negative or free of sputum. Hurford (1941) found that in 35 out of 54 thoraco-plasty patients the disease was quiescent one year after operation, whereas in only seven out of another series of 44 who had refused the operation was it quiescent, and Hagn-Meincke (1950) in a late follow-up of 420 patients found that 46% were healthy compared with only 5.7% of 695 patients treated conservatively in an earlier period. The introduction of resection in the treatment of pulmonary tuberculosis has focused more attention on the results of thoracoplasty. At present adequate comparisons between the two types of operation are not possible in this country, since the only large series ofcases treated by resection has been published by the where many cases which would not be suitable for thoracoplasty are treated by resection. It does appear, however, as if resection produced a higher figure for immediate sputum conversion than a thoracoplasty, although if a thoracoplasty fails to bring about sputum conversion resection is usually still possible. In an attempt to throw more light on this problem of how to manage the patient whose sputum is still positive following a thoracoplasty, we have investigated the results of the "failed" thoracoplasty (where sputum conversion did not result) as compared with the " successful " operation (where sputum conversion resulted), and present the results in life-table form. The provision of a control series to these two groups is always difficult when considering a chronic disease. An untreated series does not form a satisfactory control, since there is always a strong tendency to select patients of more favourable outlook for treatment. Hurford (1941) in his series of thoracoplasty cases compared his results with those who had refused the operation. These two groups are not truly comparable, since the latter group was less cooperative , an important factor in a disease such as tuberculosis. We felt, therefore, that the only comparison possible was with a large general group …