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 haemothorax (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:
Open Thoracotomy: A thoracotomy is an open surgical procedure. Your doctor makes an incision of about 4 inches on your chest. This technique allows your surgeon to directly view and access the surgical area. The thick peel or capsule covering the lungs is exposed and removed carefully. The debris is cleaned using a scalpel and any blood present in the pleural cavity is removed by suction to prevent infection. The lungs are checked for complete expansion. The underlying tissue and the skin are closed firmly using stitches.
Video-assisted Thoracoscopic Surgery (VATS): Your doctor will make small incisions on the skin above the chest cavity to insert a thoracoscope and surgical instruments. The thoracoscope, a long thin tube with a camera and light source is inserted to examine the pleura and lungs. The peel encapsulating the lungs is carefully removed in a piecemeal fashion (piece by piece) to avoid air leaks, and any pus and debris are sucked out. The underlying tissues and skin are sutured.
Decortication surgeries are performed with extreme care in order to prevent damage to the lungs and neighbouring 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.
Risks and Complications
Like all surgical procedures, decortication may be associated with certain risks and complications, which can be treated appropriately.
VATS vs. Open Thoracotomy
The VATS technique has proven to have better outcomes with less pain and shorter recovery than open thoracotomy, and is recommended for early effusion when the capsule is thin. However, an open approach is suggested to remove a thick capsule that could have fused to the chest cavity and lung, as a thoracoscopy is more difficult to perform and may be associated with chances of injury.
Dr. Andrew Newcomb will discuss your options and plan the best treatment procedure that will provide you with optimal outcomes. Please call Dr. Andrew Newcomb on (03) 9419 2477, for more information on decortication procedure.