The lungs are separated from the chest wall by a narrow space called the pleural cavity, which consists of pleural fluid. Some cases of pneumonia can lead to the collection of excess pleural fluid, which may get infected and lead to the deposition of an infected protein material on the surface of the lungs and chest wall (pleural effusion). The pleural fluid can solidify and form a capsule around the lung. As the capsule increases in size, it can entrap the lung, making it difficult to expand and deflate.
Decortication is a surgical procedure performed to remove the fibrous capsule formed around the lung. The procedure aims at regaining the normal functioning of the lungs.
Decortication is indicated for patients suffering from pneumonia (lung infection), chronic empyema (pleural space infection), iatrogenic infection after pleural tap (infection following the diagnostic/therapeutic removal of fluid or air from the pleural space) and septicaemia (bacterial infection in the blood). Decortication is also performed for the treatment of fibrothorax (formation of fibrous tissue in the pleural space) and post-traumatic hemothorax (blood accumulation in pleural space).
You doctor will collect your complete medical history and perform a thorough physical examination. You may be advised to get a pulmonary function test to measure your lung volume, airflow, mechanism and gas exchange, and determine the extent of dysfunction. You doctor may suggest a cardiopulmonary exercise test to assess the cardiac risk factors before decortication. Spirometry (a test that measures lung function), blood gas test, CT scan and chest radiograph may be necessary to determine the intensity of lung dysfunction. Bronchoscopy, a test to view the airways, may be required to diagnose lung diseases that may cause lung collapse.
Decortication is of two types, and is performed under general anaesthesia:
Decortication surgeries are performed with extreme care in order to prevent damage to the lungs and neighboring tissues.
After the surgical procedure, imaging tests of your chest may be taken to determine complete recovery. Your doctor may recommend analgesic medicines to provide relief from post-operative pain. Cardiac monitoring may be conducted for 48 hours after the surgery. You may be encouraged to get out of bed and walk as soon as possible after the procedure. Your doctor may also recommend oxygen (administered through a small tube strapped under your nose) and nebulizer therapy (inhalation of a fine mist of medication through a mouth piece or mask). The average stay in hospital after VATS may be 48-72 hours and 3-5 days after the open thoracotomy procedure. Chest physiotherapy may be advised after you recover completely.
Like all surgical procedures, decortication may be associated with certain risks and complications, which can be treated appropriately.