Decortication of lung

Decortication of lung is a surgical procedure aimed at removing the fibrous layer of tissue covering the lung (the pleura) when it becomes thickened and inelastic due to disease or injury. This condition, known as pleural effusion or empyema, can significantly impair lung function by restricting lung expansion, leading to difficulty in breathing and decreased oxygenation of blood. Decortication is performed to restore lung function by allowing the lung to re-expand.

Indications

Decortication of lung is indicated in cases where conservative treatments for pleural effusion or empyema, such as antibiotics or thoracentesis, have failed. Conditions that may require decortication include:

• Chronic empyema with thickened pleura
• Pleural effusion that is not responsive to medical treatment
• Pneumothorax associated with fibrous pleural peel
• Lung abscess or pneumonia leading to the formation of a fibrous layer over the lung

Procedure

The procedure can be performed through traditional open thoracotomy or using minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS). The choice of technique depends on the extent of the disease, the patient's overall health, and the surgeon's expertise.

1. 1. 1. Open Thoracotomy

In an open thoracotomy, a large incision is made on the side of the chest to fully access the lung. The surgeon then carefully removes the fibrous layer without damaging the lung tissue underneath.

1. 1. 1. Video-Assisted Thoracoscopic Surgery (VATS)

VATS involves making several small incisions in the chest and inserting a thoracoscope (a small camera) and surgical instruments. This technique allows the surgeon to view the lung and remove the fibrous layer with minimal incisions, reducing recovery time and complications.

Recovery

Postoperative care is crucial for a successful recovery. Patients may need to stay in the hospital for several days to monitor their recovery and manage pain. Physical therapy may be recommended to improve lung function and facilitate the return to normal activities. The recovery period varies depending on the extent of the surgery and the patient's overall health.

Risks and Complications

As with any surgical procedure, decortication of lung carries risks, including:

• Infection
• Bleeding
• Pneumonia
• Respiratory failure
• Reaccumulation of fluid around the lungs

Outcomes

The outcomes of lung decortication are generally positive, with most patients experiencing significant improvement in symptoms and lung function. However, the success of the procedure depends on the underlying cause of the pleural effusion or empyema, the patient's health status, and the presence of any complications.