BACKGROUND The treatment of pulmonary tuberculosis has evolved through multiples of treatment modalities including pulmonary surgery. In Ethiopia, though the disease is very common, there is no information regarding the patterns of surgically treated pulmonary tuberculosis and its outcome. OBJECTIVE AND STUDY DESIGN A retrospective clinical study was conducted to investigate the patterns and outcomes of surgically treated cases of pulmonary tuberculosis. Data was collected from the clinical records of all patients operated at the chest surgery unit with a confirmed diagnosis of pulmonary tuberculosis at the Tikur Anbessa teaching specialized referral hospital (26). RESULT Twenty-six patients were admitted for surgery, 80.8% of these patients were males. The mean duration of illness before presenting to the hospital was 27.6 months. Cough and hemoptysis were the two most common presenting symptoms, occurring in 26 (100%) and 24 (92.3%). The most common feature seen in chest x-rays was a completely destroyed lung tissue in 10 (38.5%). The parts of the lung commonly involved were the left side in 16 (61.5%) and the upper lobes in 14 (53.8%). The Sputum examination for acid-fast tubercle bacilli tested positive for 24 (92.3%) of the patients. The most frequent indications for surgery were severe hemoptysis for 12 (46.2%), radiographic evidence of destroyed lung for 5 (19.2%) and strong evidence for Aspergilloma for 3 (11.5%). The most frequently performed procedure were left upper lobectomy in 10 (38%), left pneumonectomy in 7 (26.7%) and right pneumonectomy in 7 (26.7%). Nine significant (34.6%) complications occurred in the postoperative period, the commonest being postoperative pneumonia in 4 (15.4%). Two (7.7%) of the patients died. During the follow-up period six patients developed significant late postoperative complications. CONCLUSION In the Ethiopian setting, though anti-tuberculous chemotherapy is the standard treatment for pulmonary tuberculosis in a majority of patients, there are still definite indications in which surgical management plays a vital role.