Decortication

What is Decortication?

Decortication is a specialized thoracic surgery that removes thick, fibrous membranes (peel) covering the lungs and chest wall. This procedure helps:
Restore normal lung expansion
Improve breathing capacity
Treat chronic infections or inflammation

When is This Procedure Necessary?

Common indications include:

• Advanced empyema (infected pleural fluid with thick coating)
• Chronic pleural thickening from tuberculosis or asbestos exposure
• Hemothorax organization (clotted blood compressing the lung)
• Post-pneumonia complications

Surgical Approaches

1. Open Decortication

• Traditional method through thoracotomy incision
• Provides direct access for extensive disease

2. VATS Decortication

• Minimally invasive video-assisted technique
• Smaller incisions, faster recovery
• Suitable for early-stage cases

3. Robotic-Assisted Approach

• Enhanced precision in complex cases
• Available at advanced thoracic centers

The Surgical Process

1. General anesthesia administration
2. Incision (size depends on approach)
3. Peeling away fibrous layers from lung surface
4. Drainage of infected material
5. Placement of chest tubes
6. Closure and transfer to recovery

Recovery Timeline

Potential Benefits

• 50-70% improvement in lung function
• Resolution of chronic infections
• Reduced shortness of breath
• Prevention of recurrent complications

Possible Risks

• Prolonged air leak (most common)
• Bleeding or infection
• Respiratory failure in severe cases
• Reaccumulation of fluid (rare)

Long-Term Outcomes

• Most patients report significant symptom relief
• Pulmonary rehabilitation enhances recovery
• Follow-up imaging monitors lung re-expansion

Alternative Treatments

• Intrapleural enzyme therapy (for early-stage cases)
• Long-term drainage catheters (for high-risk patients)

Conclusion

Decortication can dramatically improve quality of life for patients with advanced pleural disease. The choice between open and minimally invasive techniques depends on disease severity and patient factors.