Name of the Procedure:

Decortication, Pulmonary (Partial)
Common name(s): Partial pulmonary decortication, thoracoscopic decortication

Summary

Partial pulmonary decortication is a surgical procedure that removes the thick, fibrous layer (pleura) that covers the lungs, chest wall, and diaphragm. This layer can become abnormally thick and stiff due to infection, chronic inflammation, or other conditions, restricting lung function and causing significant discomfort.

Purpose

Partial pulmonary decortication is performed to treat conditions that cause the lung's pleura to thicken and harden. The goal of the procedure is to improve lung expansion, decrease pain, and enhance breathing function by removing the restrictive fibrous tissue.

Indications

• Empyema (collection of pus in the pleural space)
• Chronic pleuritis (inflammation of the pleura)
• Fibrothorax (fibrosis of the pleural space)
• Recurrent pleural effusions (fluid buildup in the pleural space)

Patient criteria may include failure to respond to less invasive treatments such as antibiotics or drainage procedures.

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Necessary diagnostic tests such as chest X-rays, CT scans, or pulmonary function tests may be required.
• Review and adjust current medications under physician guidance, especially blood thinners or anti-inflammatory drugs.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A small incision or several small incisions are made in the chest to access the pleural cavity.
3. Thoracoscopic Entry: A thoracoscope (a type of endoscope) is inserted to visualize the pleural space.
4. Removal of Fibrous Tissue: Specialized instruments are used to meticulously peel away and remove the thickened pleura covering the lung and chest wall.
5. Closure: The incisions are closed, and a chest tube may be inserted to drain any excess fluid or air, which helps the lung re-expand.

Duration

The procedure typically takes between 2 to 4 hours, depending on the extent of pleural thickening and complexity.

Setting

Partial pulmonary decortication is usually performed in a hospital operating room.

Personnel

• Thoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technician

Risks and Complications

• Infection
• Bleeding and hematoma formation
• Air leaks from the lung
• Injury to surrounding tissues or organs
• Prolonged air leak requiring additional interventions
• Anesthesia-related complications

Potential complications are managed by the surgical team during and after the procedure.

Benefits

• Improved lung function and expansion
• Relief from pain and discomfort
• Reduction or elimination of chronic infection and inflammation
• Enhanced overall quality of life

Benefits are often realized shortly after recovery, with progressive improvement over time.

Recovery

• Hospital stay of several days to monitor recovery and ensure lung function improves.
• Pain management with prescribed medications.
• Instruction on breathing exercises and physical activity.
• Follow-up visits for assessment and removal of the chest tube if inserted.

Most patients can return to normal activities within 4 to 6 weeks, depending on their overall health and response to the surgery.

Alternatives

• Antibiotic therapy and drainage for infection control
• Pleural effusion drainage through needle aspiration or chest tube insertion
• Pleurodesis (chemical or surgical fusion of pleura to prevent fluid accumulation)

Each alternative has its pros and cons related to effectiveness, invasiveness, and recovery time.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain or discomfort. Post-procedure, patients may experience some pain at the incision site, managed with medications. Discomfort from the chest tube, if used, is also common and typically resolves once removed. Patients might experience improved breathing function soon after the recovery phase, contributing to an overall enhanced quality of life.