Decortication and parietal pleurectomy
CPT4 code
Name of the Procedure:
Decortication and Parietal Pleurectomy
Common Names: Lung Decortication, Pleurectomy, Pleural Decortication
Summary
In layman's terms, decortication and parietal pleurectomy is a surgical procedure that involves the removal of the fibrous layer covering the lung (decortication) and part of the pleura, which is the membrane surrounding the lungs (pleurectomy). This helps the lungs to expand properly and improve breathing.
Purpose
- Medical Condition: Addresses conditions such as empyema (infection in the pleural space), pleural effusion (fluid accumulation), mesothelioma, or trapped lungs.
- Goals/Outcomes: The goal is to remove restrictive fibrous tissue and infected or cancerous pleura, thereby enhancing lung function and easing symptoms like difficulty breathing.
Indications
- Symptoms of chronic pleural empyema, including pain, fever, and respiratory distress.
- Non-resolving pleural effusion causing lung compression.
- Diagnosed pleural conditions such as mesothelioma or other pleural malignancies.
- Failure to respond to less invasive treatments like antibiotics or tube thoracostomy.
Preparation
- Fasting: Patients are usually required to fast for 8-12 hours before the surgery.
- Medications: Certain medications might need to be paused, particularly blood thinners.
- Tests: Preoperative imaging (CT scan, X-ray), blood tests, and pulmonary function tests are often necessary.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
- Incision: A surgeon makes an incision in the chest to access the pleural space.
- Decortication: The fibrous layer restricting the lung is carefully peeled away.
- Pleurectomy: Part or all of the diseased parietal pleura is excised.
- Drain Placement: Chest tubes are placed to drain fluid and air.
- Closure: The incision is closed with sutures or staples.
- Dressings: Sterile dressings are applied to the wound site.
Tools/Equipment: Scalpel, thoracoscopic camera (in minimally invasive approaches), forceps, sutures, chest tubes.
Duration
Typically, the procedure lasts between 2 to 4 hours, depending on its complexity and the patient’s condition.
Setting
Performed in a hospital setting, usually in an operating room equipped for thoracic surgery.
Personnel
- Surgeons: Thoracic surgeon specialized in the chest and lung surgeries.
- Nurses: Operating room and surgical nurses.
- Anesthesiologists: Monitor and manage anesthesia throughout the procedure.
- Respiratory Therapists: May assist before and after surgery.
Risks and Complications
- Common Risks: Infection, bleeding, pain, and prolonged air leaks.
- Rare Complications: Respiratory failure, injury to nearby organs, or blood clots.
- Management: Close monitoring and supportive care post-surgery.
Benefits
- Expected Benefits: Relief from symptoms like pain and breathlessness, improved lung function.
- Timeline: Benefits typically start to be noticeable within days to weeks after the surgery.
Recovery
- Post-Procedure Care: Pain management, breathing exercises, and mobilizing soon after surgery.
- Recovery Time: Hospital stay of about 5-7 days, with full recovery taking several weeks.
- Restrictions: Limited heavy lifting, follow-up appointments to remove chest tubes and monitor healing.
Alternatives
- Other Options: Antibiotics for infections, less invasive drainage procedures (thoracentesis), tube thoracostomy, chemical pleurodesis, or systemic chemotherapy for cancers.
- Pros and Cons: Alternatives may be less invasive but might not be as effective in severe or complex cases.
Patient Experience
During the surgery, the patient is under general anesthesia and will not feel anything. Post-surgery, there may be pain controlled with medications. The patient might experience discomfort from chest tubes and is encouraged to follow breathing exercises to aid recovery.