Overview of Decortication Treatment India

Decortication is a surgical procedure to remove the fibrous layer around the organ. It is mainly performed to remove fibrous tissue over the chest wall, lung and diaphragm. There is a thin membrane between the outer surface of the lungs, known as visceral pleura, and inner surface, known as parietal pleura. The space between lungs and chest wall is known as pleural space, and is 1 mm thick. In some health conditions, such as pneumonia, or bleeding in the chest, this pleural space can be filled with fluid. Over time, this fluid can be solidified into the shape of a capsule. This can cause infection known as empyema, and solidified material on lungs is known as pleural peel. Empyema is categorized into three stages: exudative, fibrinopurulent and organized.

01. In the exudative stage, fluid is in pleural space due to the initial inflammatory process and is in the first week.

02. In the Fibrinopurulent stage, fluid tends to migrate from lung parenchyma.

03. In an organized stage, the fluid produces a thick cortex over the lungs. This stage limits the spread of infection, however, it restricts lung expansion.

This pleural space is affected by pathologic disorders that can lead to other health problems. One of the main problems is fibrothorax, which is an abnormal collection of scar tissue. These deposits on the lungs can be severe and prevent them from expanding. It shrinks the ribs together. After some time, the lungs become entrapped due to which breathing is difficult. When this peel is removed with thoracoscopic decortication, the lung expands to normal size and deflates, improving the patient's symptoms. Antibiotics are the first step to treat this disorder.

Types of Decortication Treatment India

When the pleural peel is in the exudative stage and has been present for at least 3 weeks (fibrinopurulent phase), thoracoscopic surgery is successful. When it has been present for more than 3 weeks (organizing phase), it is difficult to perform surgery due to dense adhesions. Patients with fibrinopurulent phase CT scan cannot help to predict it.

Before Procedure

The treatment of fibrothorax depends on the stage, but the main aim of treatment is drainage of the fluid and re-expansion of the lung. The thoracoscopic decortication is performed under general anesthesia.

During Procedure

There are two types of techniques of decortication and the surgeon will decide which technique to choose depending on the extent of disease.

01. Open Thoracotomy - This technique helps surgeons to directly see and analyze the surgical area. It is the only option when minimally invasive surgery cannot treat the disorder. It is open surgery in which a surgeon makes an incision of four inches over the chest. The pleural peel around the lung will be exposed and removed. Debris will also be removed from the cavity to prevent the infection. The incision will be sutured once the procedure is done.

02. Video-assisted thoracoscopic surgery (VATS) - In this procedure, small incisions are made above the chest. A thoracoscope and surgical instruments are inserted in the chest cavity through the incision. The thoracoscope has a camera with a light source. The pleural peel is removed carefully and debris is cleared. The hospital stay is of 2 to 3 days post-surgery.

After Decortication

After thoracoscopic decortication procedure, patients need to stay in hospital for 5 to 7 days. There will be 1 to 3 small tubes inserted in the body to drain fluid. Patients will need to take antibiotics and painkillers medications for a few days post-surgery. You can start eating a liquid diet and gradually resume back to a regular diet. Patients need to walk as much as possible. Doctors may recommend chest physiotherapy post-surgery.

Diagnosis of Decortication Treatment India

Purpose of Decortication

One of main reasons for lung decortication is fibrothorax, which leads to lung restrictions. This can cause difficulty in breathing, including other decortication indications such as:

01. Decreased activities

02. Reduced chest wall movement

03. Chest discomfort

04. Reduced breath sounds

05. Coughing

06. Chest pain, especially while deep breathing

The factors that contribute to fibrothorax are:

01. Lung infection

02. Empyema

03. Spesis

04. Hemothorax

05. Exposure to chemicals

06. Iatrogenic Infection

Diagnosis

Before choosing any treatment, doctors need to know the underlying disease such as fibrothorax. He or she can ask for:

01. Chest X-ray - It helps to detect problems in lungs with the help of projection radiographs. The underlying disease is occasionally detected in the X-ray.

02. CT Scan - It produces high resolution images which helps doctors to analyze whether the pleural is present or not, and the reason for its thickening - extra fat deposition or true pleural.

Symptoms and Risk factors

Complications after Decortication

Like any other surgery, decortication has some complications and risks that are manageable. Some of the common complications are:

01. Infection

02. Bleeding

03. Air leak from chest cavity

04. Cardiac complications

05. Broncho-pleural fistula

06. Respiratory failure

07. Damage to nearby organs

Treatment Costs for Decortication

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Decortication - Frequently Asked Questions

Thoracoscopic decortication is a surgical procedure to remove a solidified layer of fibrous membrane on the lungs, diaphragm, and chest wall.

The surgery time depends on how many tumors are attached to lungs. Generally, this surgery takes 2 to 4 hours.

Pleurectomy involves removal of the pleura or lung lining. Decortication is a procedure to remove visible tumors from the lungs surface.

VATS (Video-assisted thoracoscopic surgery) is a procedure in which a surgeon makes a small incision between the ribs and insert a small tube called a thoracoscope. This small tube has a small camera at the end. This camera allows the surgeon to see the chest cavity from inside without making a large incision in the chest.

It is simple surgery and involves the excision of the thick peel from the surface of the lungs.

The main purpose behind this surgery is to allow the lungs to expand, reduce breathing problems and relieve other lung problems.

It is a serious condition that requires immediate treatment. It is a type of infection that can cause chest pain, fever, breathlessness and coughing. In rare cases, it can be proved as life-threatening.

Yes, the pleural can regenerate after VATS pleurectomy.

It is one by a procedure known as Thoracentesis in which fluid or air around the lungs is removed. A small needle is inserted in the chest wall into the pleural space. It is the gap between the surface of the lung and inner chest wall. In this gap, there is a small amount of fluid that prevents lungs and chest wall from rubbing together while breathing.

You will be shifted to the recovery room of the hospital for 1 week. A medical staff will monitor your overall health conditions post-surgery, including heart rate, pulse, breathing and BP.

The aim of pleurectomy is removing part of the pleura to prevent collecting the fluid.

The recovery time depends on the type of surgery you had. Generally, patients are advised to take rest for at least 2 to 3 weeks.

It is a collection of pus in the cavity between the chest wall and lungs.

Chest X-ray is the first step to diagnose empyema. This diagnostic test identifies empyema when there is a large amount of fluid in the cavity. If the doctor suspects there is liquid, he or she will recommend ultrasound. 

The non-surgical options include inserting a needle in the chest wall to drain pus. 

Video-assisted thoracoscopic surgery requires a hospital stay of 2 to 3 days. In your hospital stay, the medical team will analyze your health and complications, if any.