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.
Types of Decortication Treatment India
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.
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:
- Decreased activities
- Reduced chest wall movement
- Chest discomfort
- Reduced breath sounds
- Coughing
- Chest pain, especially while deep breathing
The factors that contribute to fibrothorax are:
- Lung infection
- Empyema
- Spesis
- Hemothorax
- Exposure to chemicals
- 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:
- Infection
- Bleeding
- Air leak from chest cavity
- Cardiac complications
- Broncho-pleural fistula
- Respiratory failure
- Damage to nearby organs
11/22/2025
