Name of the Procedure:

Decortication, pulmonary (separate procedure); total

Summary

Pulmonary decortication is a surgical procedure to remove a thickened layer of fibrous tissue, called the pleural peel, from the surface of the lung. This layer can restrict lung expansion and impair breathing. The procedure involves accessing the lung through the chest wall to remove this constrictive layer.

Purpose

Pulmonary decortication is performed to treat conditions where the pleural peel restricts lung function, commonly due to infections like empyema, chronic inflammation, or fibrosis. The goal is to restore full lung expansion and improve respiratory function.

Indications

• Persistent pleural effusion
• Empyema (collection of pus in the pleural space)
• Fibrothorax (thickening of the pleura due to chronic inflammation)
• Lung conditions unresponsive to other treatments
• Symptomatic pleural thickening causing restrictive lung disease

Preparation

• Fast for at least 8 hours before surgery.
• Adjust medications as directed by your healthcare provider.
• Undergo preoperative testing such as blood tests, chest X-ray, CT scan, or pulmonary function tests.
• Ensure any infections are managed and controlled prior to surgery.

Procedure Description

1. Administer general anesthesia to put the patient to sleep.
2. Make an incision in the chest wall (thoracotomy) to access the lung.
3. Carefully peel away the thickened pleural layer from the lung surface.
4. Ensure all areas of constriction are addressed to allow full lung re-expansion.
5. Insert drainage tubes to remove any fluid buildup post-surgery.
6. Close the incision with sutures or staples.

Tools and equipment include surgical knives, forceps, suction devices, and drains. The procedure is performed under general anesthesia to ensure the patient is unconscious and pain-free.

Duration

The surgery typically takes between 2 to 4 hours, depending on the extent of the disease and complexity of the case.

Setting

Performed in a hospital operating room equipped with thoracic surgical facilities.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Surgical nurses
• Respiratory therapists (post-op care)

Risks and Complications

• Infection
• Bleeding
• Air leaks from the lung (pneumothorax)
• Respiratory complications
• Reaction to anesthesia
• Prolonged air leak or need for reoperation

Benefits

• Improved lung function and breathing capacity.
• Relief from symptoms such as shortness of breath, pain, and chronic cough.
• Increased overall quality of life.

Recovery

• Hospital stay of about 5 to 7 days post-surgery.
• Pain management with medications.
• Instructions on deep breathing exercises and use of incentive spirometry.
• Avoid heavy lifting or strenuous activities for several weeks.
• Follow-up appointments to monitor recovery and lung function.

Alternatives

• Conservative management with antibiotics and drainage (for infections).
• Video-assisted thoracoscopic surgery (VATS) for less complex cases.
• Thoracentesis or pleurodesis to manage fluid accumulation.

The alternatives are generally less invasive but may not be as effective in severe cases where the pleural peel is extensive and impacts lung function significantly.

Patient Experience

During the procedure, patients are under general anesthesia and will not feel anything. Post-operatively, patients may experience pain and discomfort at the incision site, controlled with pain medications. The use of breathing exercises and physical therapy is crucial to recovery and can be somewhat uncomfortable initially but improves over time.