Lung decortication is a surgical procedure to remove a thick, fibrous layer that forms around the lung. This restrictive layer, often called a “peel,” prevents the lung from expanding fully and functioning properly. The goal of decortication is to free the lung from this constricting tissue, restoring its ability to inflate and deflate normally, and improve breathing.
Conditions Requiring Decortication
Lung decortication is necessary when medical conditions lead to a restrictive fibrous layer around the lung, impairing its function. A common reason is chronic empyema, where pus accumulates in the pleural space between the lung and inner chest wall. This infection can thicken pleural membranes, forming a rigid peel that traps the lung. Symptoms often include persistent fever, chest pain, shortness of breath, and a cough.
Another condition is “trapped lung” or fibrothorax, where chronic inflammation results in a dense, inelastic fibrous layer over the lung. This fibrous tissue can prevent the lung from expanding even after fluid drainage, leading to a chronically restricted lung. Patients with trapped lung often experience ongoing shortness of breath and decreased chest wall movement. Diagnosis involves imaging tests like CT scans and chest X-rays, which reveal the extent of pleural thickening and lung entrapment.
The Surgical Process
Lung decortication is a major thoracic operation performed under general anesthesia. The procedure carefully peels away the fibrous membrane from the lung surface, inner chest wall, and sometimes the diaphragm. This separation allows the compressed lung to re-expand. Surgeons must avoid damaging underlying lung tissue or nearby structures.
The surgery can be approached in two ways: open thoracotomy or video-assisted thoracic surgery (VATS). Thoracotomy involves a larger incision, typically between the ribs, providing direct access. VATS is a less invasive technique using small incisions for a thoracoscope (a thin tube with a camera and light) and specialized instruments, allowing video-guided operation. While VATS is often preferred for benefits like less pain and shorter hospital stays, open thoracotomy may be necessary for complex cases involving dense adhesions or severely compromised lung tissue.
Post-Operative Care and Recovery
Following lung decortication, immediate post-operative care focuses on managing pain and facilitating lung re-expansion. Patients typically have chest tubes inserted to drain fluid or air from the pleural space, usually removed within days. Pain management is a priority, often involving medications to ensure comfort and encourage early mobilization. Hospital stays range from a few days for VATS to one to two weeks for open thoracotomy.
Physical therapy and breathing exercises are integral to recovery. Patients are encouraged to perform deep breathing exercises, use incentive spirometers, and engage in early mobilization to help the lung re-expand and regain strength. These activities also clear secretions and prevent complications like pneumonia or atelectasis. While complications like air leaks or bleeding are possible, they are rare and managed by the medical team. Full recovery, including a return to normal activities, can take several weeks to a few months, varying by individual and surgery extent.