Plombage is Not a Recommended Treatment for Tuberculosis
Plombage is an obsolete surgical procedure that is no longer recommended for tuberculosis treatment, having been completely replaced by effective antimicrobial therapy regimens. 1
Historical Context and Modern Treatment Approach
Plombage was a surgical collapse therapy used in the 1930s-1950s before the introduction of effective antimicrobial drugs. The procedure involved creating a cavity surgically under the ribs in the upper chest wall and filling the space with inert material (such as Lucite spheres or paraffin) to collapse the lung, theoretically promoting healing and limiting the spread of tuberculosis 2.
Modern tuberculosis treatment relies entirely on antimicrobial therapy:
For drug-susceptible TB: A 6-month regimen consisting of:
For eligible patients, a newer 4-month regimen may be used:
- Intensive phase (8 weeks): Rifapentine, isoniazid, pyrazinamide, and moxifloxacin
- Continuation phase (9 weeks): Rifapentine, isoniazid, and moxifloxacin 1
Complications of Plombage
Plombage has been associated with significant long-term complications that can emerge decades after the procedure:
- Infection of the foreign material
- Migration of plombage materials into surrounding structures
- Erosion into the lung, chest wall, or esophagus
- Hemoptysis
- Respiratory insufficiency
- Pleurocutaneous fistula formation 4, 2
These complications often require surgical intervention to remove the foreign material, sometimes as long as 55 years after the initial procedure 2.
Current Treatment Guidelines
Current guidelines from major respiratory and infectious disease societies make no mention of plombage as a treatment option. The Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), American Thoracic Society, and Infectious Diseases Society of America all recommend antimicrobial regimens as the standard of care 3, 1.
The development of effective antimicrobial therapy has completely replaced surgical interventions for primary treatment of tuberculosis:
- Streptomycin was discovered in 1945
- Isoniazid in 1952 opened the modern era of TB treatment
- Rifampin in the 1970s enabled reduction of treatment to 9 months
- Addition of pyrazinamide further reduced treatment to 6 months 5
Surgical Interventions in Modern TB Management
While plombage is obsolete, certain surgical interventions may still be required in TB management:
- Drainage of cold abscesses
- Excision of necrotic tissue
- Removal of infected tissue
- Wide excision biopsy for smaller lesions
- Core biopsy for larger lesions 1
However, these are adjunctive to antimicrobial therapy, not replacements for it.
Key Takeaway
Any patient with tuberculosis should receive appropriate antimicrobial therapy according to current guidelines, not surgical collapse therapy such as plombage. Patients who previously underwent plombage should be monitored for potential complications, and the foreign material should be removed if complications develop 2.