Place of surgery in the management of lymph node tuberculosis

<b>Introduction:</b> Nodal tuberculosis is considered as the most frequent extra-pulmonary localization of tuberculosis. It represents a diagnostic and therapeutic challenge especially in endemic countries such as Tunisia. We herein describe the place of surgery in the management of lymph node tuberculosis. <b>Methods:</b> We have retrospectively reviewed&nbsp;51 cases operated on between 2000 and 2020 in the thoracic surgery department of Abderrahmen Mami Hospital in Ariana, TUNISIA. The lymph node biopsies by elective approach performed under local anesthesia were excluded from our study. <b>Results:</b> There were 20 males and 31 females with a sex ratio of 0,64. The mean age was 44 years with extremes ranging from 16 to 75 years. A personal history of tuberculosis was noted in 3 cases. All&nbsp;patients were hospitalized for a diagnostic evidence. Computed tomography showed mediastinal (n=51) and peripheral lymph node (n=2). The hypodense, necrotic character of the adenopathies on the CT scan was an element of orientation. The surgical approaches were a mediationoscopy (n= 44), a video-assisted thoracotomy (n=3), a sternotomy (n=1), a mini-thoracotomy (n=1) and an elective approach (n=2). The procedure consisted of lymph node biopsy. The postoperative course was uneventful for all patients. <b>Conclusion:</b> Surgery retains a place in the diagnostic strategy, if non-invasive means, particularly cytology, were not contributory and when neoplastic disease is suspected.