Decortication is a medical procedure where the pleural lining surrounding an internal organ is either partially removed with the removal or several layers, or in some cases completely removed, depending on the severity of the condition being treated. The procedure can be performed on many of the major organs, such as the heart, liver, brain, although a majority of the time it’s performed on the lungs. There are a handful of conditions that can be successfully treated with decortication, Empyema being the most commonly treated condition.
Empyema – Some Basic Information
Under normal circumstances the pleural space between the chest and lungs is naturally moist which allows for very smooth sliding between the lungs and the inner chest wall. Under these normal circumstances there’s no air or fluid in the pleural space and the lungs are free to expand completely. For individuals who have Empyema this isn’t the case.
Empyema is a used to describe an infection in the pleural space of any organ, although again a majority of the time it affects the lungs rather than other major organs. The condition usually develops when fluid in the pleural space becomes infected, which then gets spread onto the lung itself – the infected fluid on the lung is referred to as pleural peel. In individuals who have Empyema the lungs are compressed by the infected fluid, which limits how much they’re able to expand causing shortness of breath and coughing. The infection itself, like most infections, also typically causes abnormally high fevers and an overall ill feeling for those suffering from Empyema.
Plural Space Diagram - Decortication
How Decortication Can Help With Many Different Conditions
Through decortication excess (infected) fluid that has accumulated in the pleura lining of an organ is removed. This is fluid that when left untouched can build up to cause severe pain and discomfort, and when infected can cause severe illness and possibly death if left untreated. When dealing with fluid that isn’t infected decortication is used for relief rather than a cure. There are many illnesses that can cause fluid buildup in organs and while removing the fluid through decortication likely won’t completely solve the problem it will relieve most of the pain associated with the condition. When dealing with infected fluid decortication is a very effect cure, as the fluid buildup is caused by the infection itself; remove the infection and fluid accumulation will in most cases cease.
Is Decortication Safe and Effective?
Decortication is a procedure that holds a very low mortality rate; only 1-2% of patients die during, or due to decortication (the chances being much lower if you’re being seen by an experience surgeon). About 90% of patients see improvement of their symptoms and the most common side-effect, prolonged air leaks, only occurs in one of ten patients.
The Procedure – A Closer Look
Thanks to modern technology decortication is a very simple procedure, which with video-assisted surgery will leave little to no scarring when performed by a well-trained surgeon. The procedure differs very little when done on different organs. The steps below illustrate the procedure step by step being used to treat Empyema on a Lung with video-assistance. Open decortication is not recommended unless absolutely necessary – it can cause significantly more scarring and possible complications.
Lung Decoritcation Surgery
- The patient is laid out horizontally and sedated through the use of anesthesia. Once the patient is completely unconscious the surgeon makes a small posterolateral thoracotomy incision (incision made on one side of the chest used to enter the chest wall) about 2-4 centimeters long. An index finger is used to enter the incision to fully inspect and asses the severity of the present infection.
- A Thoracoport is inserted and attached to a camera and TV – this will act as the surgeon’s “eyes” during the surgery, allowing the surgeon to perform the surgery without making any large incisions.
- Fibrous deposits on the Lung and chest wall are removed through the use of a suction device. A second Thoracoport is inserted to prevent the lung from attaching itself to the chest wall while the suction device is used. Deposits that cannot be removed with the suction device are removed using medical forceps. Completely removing fluid from the costo-phrenic sulcus is stressed to prevent any kind of future immobility. When the lung is fully dethatched from the chest wall the surgeon can proceed to the next step.
- A third Thoracoport incision is made, which will also serve as a forcep entry. This incision is identical to the first. A dissection planeis created between the lungs and tissue surrounding the lungs – the layer surrounding the lungs is fully dissected and separated from the lung. Forceps are then used to remove the dissected tissue. This process of steps 3 and 4 continue for 1-4 hours as the lung is completely decorticated and the pleural peel is completely removed.
- When the entire pleural lining is removed two chest tubes are inserted through two of the Thoracoport incisions. The operated cavity is then rinsed with a Salt solution to ensure sterility and the operated lung is inflated to end the surgery.
Post-Decortication Recovery
Most patients can expect to stay in the hospital for several days, up to a week, after surgery to assist in recovery and ensure no serious complications arise. The first few days after surgery the chest wall usually continues to lose a little blood and there’s also the possibility of air leaks occurring during the first week after surgery. After about a week or so patients can safely go home where they’re expected to rest for another 3-4 weeks while the operated areas fully heal; if the decortication was performed on a lung deep breathing exercises are recommended to help strengthen the muscles as well as promote flexibility. It’s very important to avoid physical activities during the first 2 months of recovery. Any kind of blow dealt to the chest area could potentially open partially-healed wounds inside.
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