Comparative Outcomes of Surgical Versus Medical Management of Ileocaecal Tuberculosis in a Single Tertiary-Care Centre

Abstract

Background: Ileocaecal tuberculosis (ICTB) represents the commonest form of gastrointestinal tuberculosis and poses a therapeutic dilemma when complications arise. While anti-tubercular therapy (ATT) achieves high cure-rates, obstruction, perforation or haemorrhage may necessitate surgery. Robust comparative data from South-Asian high-burden settings remain scarce.

Methods: We undertook a retrospective cohort analysis of all adults managed for ICTB between January 2018 and December 2023 at a 1 200-bed quaternary institute in northern India. Patients were stratified into a primary-medical group (≥ 6-month category I ATT) and a primary-surgical group (emergency or elective limited right hemicolectomy/stricturoplasty followed by ATT). Kaplan–Meier estimates, log-rank tests and multivariable Cox regression assessed 12-month composite success (symptom-resolution + endoscopic-healing).

Results: One-hundred patients met inclusion criteria (medical = 60; surgical = 40). Baseline age, sex-ratio and comorbidity burden were comparable. Complicated disease (multiple strictures, fistulae or perforation) was significantly higher in the surgical cohort (60 % vs 12 %, p < 0.001). At 12 months, composite success was 90 % in the surgical arm versus 80 % in the medical arm (HR 1.65, 95 % CI 1.02–2.66). Overall complication-rate was higher after surgery (20 % vs 10 %), but major (Clavien–Dindo ≥ III) events were rare (5 %). No mortality occurred.

Conclusion: In a real-world high-burden setting, surgery combined with standard ATT yielded superior clinical resolution in anatomically complicated ICTB at the cost of higher—but acceptable—morbidity. Elective surgery should be considered early for patients with advanced stricturing disease to optimise outcomes.