Decortication

Decortication
In thoracic surgery, decortication refers to a surgical procedure done to free a fibrous capsule that has formed around the lung, secondary to an inflammatory process, such as an infection. Ordinarily there is a potential space between the lung and the inside of the chest wall, with this space "lubricated" by a thin layer of fluid. In some conditions, such as pneumonia, or after an episode of bleeding in the chest, this space can fill with fluid which can eventually solidify and form a capsule around the lung. As the capsule grows, it can entrap the lung and cause problems with breathing. In a decortication operation, the surgeon works to remove this capsule and free the lung so that it can function normally.

The pleural lining surrounding an internal organ is either partially removed with the removal or several layers, or in some cases completely removed, depending on the severity of the condition being treated. The procedure can be performed on many of the major organs, such as the heart, liver, brain, although a majority of the time it’s performed on the lungs. There are a handful of conditions that can be successfully treated with decortication.

How Decortication Can Help With Many Different Conditions

Through decortication excess (infected) fluid that has accumulated in the pleura lining of an organ is removed. This is fluid that when left untouched can build up to cause severe pain and discomfort, and when infected can cause severe illness and possibly death if left untreated. When dealing with fluid that isn’t infected decortication is used for relief rather than a cure. There are many illnesses that can cause fluid buildup in organs and while removing the fluid through decortication likely won’t completely solve the problem it will relieve most of the pain associated with the condition. When dealing with infected fluid decortication is a very effect cure, as the fluid buildup is caused by the infection itself; remove the infection and fluid accumulation will in most cases cease.

Is Decortication Safe and Effective?

Decortication is a procedure that holds a very low mortality rate; only 1-2% of patients die during, or due to decortication (the chances being much lower if you’re being seen by an experience surgeon). About 90% of patients see improvement of their symptoms and the most common side-effect, prolonged air leaks, only occurs in one of ten patients.

The Procedure – A Closer Look

Thanks to modern technology decortication is usually a very simple procedure. The procedure differs very little when done on different organs. Open decortication is not recommended unless absolutely necessary – it can cause significantly more scarring and possible complications.

Lung Decoritcation Surgery

1. The patient is laid out horizontally and sedated through the use of anesthesia. Once the patient is completely unconscious the surgeon makes a small posterolateral thoracotomy incision (incision made on one side of the chest used to enter the chest wall) about 2-4 centimeters long. An index finger is used to enter the incision to fully inspect and asses the severity of the present infection.
2. A Thoracoport is inserted and attached to a camera and TV – this will act as the surgeon’s “eyes” during the surgery, allowing the surgeon to perform the surgery without making any large incisions.
3. Fibrous deposits on the Lung and chest wall are removed through the use of a suction device. A second Thoracoport is inserted to prevent the lung from attaching itself to the chest wall while the suction device is used. Deposits that cannot be removed with the suction device are removed using medical forceps. Completely removing fluid from the costo-phrenic sulcus is stressed to prevent any kind of future immobility. When the lung is fully dethatched from the chest wall the surgeon can proceed to the next step.
4. A third Thoracoport incision is made, which will also serve as a forcep entry. This incision is identical to the first. A dissection planeis created between the lungs and tissue surrounding the lungs – the layer surrounding the lungs is fully dissected and separated from the lung. Forceps are then used to remove the dissected tissue. This process of steps 3 and 4 continue for 1-4 hours as the lung is completely decorticated and the pleural peel is completely removed.
5. When the entire pleural lining is removed two chest tubes are inserted through two of the Thoracoport incisions. The operated cavity is then rinsed with a Salt solution to ensure sterility and the operated lung is inflated to end the surgery.

Post-Decortication Recovery

Most patients can expect to stay in the hospital for several days, up to a week, after surgery to assist in recovery and ensure no serious complications arise. The first few days after surgery the chest wall usually continues to lose a little blood and there’s also the possibility of air leaks occurring during the first week after surgery. After about a week or so patients can safely go home where they’re expected to rest for another 3-4 weeks while the operated areas fully heal; if the decortication was performed on a lung deep breathing exercises are recommended to help strengthen the muscles as well as promote flexibility. It’s very important to avoid physical activities during the first 2 months of recovery. Any kind of blow dealt to the chest area could potentially open partially-healed wounds inside.

In Cancer:

A procedure involving lung decortication is usually recommended when the patient’s lung is not able to fully expand due to the collapsed tissue that encases the lung. This causes breathing problems and often pain. It is also a procedure that is used to clear away malignant tissue, if the disease has set in around the lungs. To reduce the risk of lung damage, this operation has to be performed with extreme care. In addition to clearing away the tissue, the surgeon also has to locate and drain any fluid or pus that has accumulated. A successful decortications of the lung can yield a beneficial sigh of relief for the patient, but not all people are considered good candidates for this procedure. It is up to the surgeon to determine if the operation should be performed on an individual.