Decortication of the lungs is a surgical procedure that is done to remove fibrous tissue that envelopes the lungs, the chest wall, and the diaphragm, to enable the normal expansion and deflation of lungs during respiration. The pleural space which is the space between the lungs and the overlying membrane called the pleura can be affected by pathological conditions resulting in the filling up of this space with fluid or tissue leading to the formation of pleural rind that prevents the normal inflation and deflation of the lungs and leads to breathing difficulties.
Decortication of lungs is an elective procedure.
There are no absolute contraindications for the decortication of lungs other than the poor general health of the individual. Relative contraindications may include:
Duration: A decortication procedure may last for a few hours depending on the extent of the underlying condition.
What is the anesthesia for the decortication of the lungs? The surgery is performed under general anesthesia with endotracheal intubation.
The individual is made to lie on the side with the affected side up and the entire chest area is cleaned and sterile draping is done. An Endotracheal Intubation is done. After the general anesthesia has taken effect a thoracotomy is done usually in the 5th or 6th intercostal space. A rib resection may also be done if required. If the pleura are fused then a pleurectomy may be done to remove the fused pleural layers. For empyema, rib dissection is done before the start of the procedure to avoid injury to other ribs, and for better visualization of the entire chest. Severe cases of empyema may require multiple rib dissections before an empyema decortication is done. The peel that is restricting the lung expansion is carefully removed with the help of a scalpel while taking care to not injure or damage the lung tissue. Once the peel and the pleural rind are removed, the lung is checked if it is re-expanding. Any leaks in the lung tissue are sewn or closed with sealants. Two chest tubes are placed for drainage. The chest is irrigated and all the blood is suctioned out.
The individual is made to lie on the side with the affected side up and the entire chest area is cleaned and sterile draping is done. An Endotracheal Intubation is done. After the general anesthesia has taken effect, a local anesthetic is given at the site of the trocar entry for the ports. The procedure is usually done via three ports or four ports and sometimes via a single port. VATS decortication is preferred during the early stages and acute cases when the peel is easier to remove and better avoided in chronic cases. The peel is usually removed with a grasper or a peanut dissector. A simple pleurectomy or a radical pleurectomy is done as required. Once the peel and the pleural rind are removed and pus or other fluids are suctioned out, the chest cavity is irrigated, two chest tubes are inserted via the port site, the scope is removed. The underlying tissue and the skin are closed. VATS decortication is the preferred procedure for decortication of lung empyema in the early stages. This is associated with better outcomes, lesser postoperative pain, and early recovery than Open Decortication.
Medications: Antibiotics and pain relievers are prescribed at the time of discharge.
Discharge: Usually 7-10 days after the procedure in the absence of any complications.
Review: The review is usually every week for the first month after discharge, and then at regular intervals thereon. A chest X-ray is done at the time of the first review.
Resumption of normal activities: Usually with some restrictions in 4-6 weeks after the procedure
The prognosis of lung surgery is generally good although they are largely dependent on the age and general health of the individual, the underlying condition, and the presence of comorbidities. Pulmonary decortication shows better results in younger individuals.
Hospitalization is required for pulmonary decortication.
Lung surgery is performed by specialists from the Department of Cardiothoracic surgery in consultation with Pulmonologists.