Decortication

Decortication is a type of surgical procedure performed to remove a fibrous tissue that has abnormally formed on the surface of the lung, chest wall or diaphragm. Generally, there is a space (called pleural space) in between the lungs and the chest wall, which is lined with a very thin fluid layer for lubrication. This area is moist to allow the lungs to expand and contract smoothly when breathing. However, certain diseases or conditions can lead to excess fluid that can fill up this gap. The excess fluid buildup is known as pleural effusion. If not fixed, the excess buildup of fluid can eventually turn solid and form a fibrous capsule that restricts and entraps the lung, causing breathing problems.

Decortication can be performed using the following methods: Minimally-Invasive (small incisions of 2–3 inches long / general anesthesia), or open-surgery (large incisions of 8-10 inches long / general anesthesia). The type of method chosen will vary based on your medical condition.

How to Prepare for Decortication Procedure

Prior to the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before Decortication Procedure

To determine whether you need this procedure, your doctor might perform a variety of diagnostic tests, including:

• Blood tests
• Ultrasound
• Computed Tomography (CT scan)
• X-Rays

What to Expect During Decortication Procedure

The procedure will typically take between 2 to 3 hours to complete. This procedure is typically performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. In general, during a minimally-invasive decortication:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• Usually, your doctor will administer general anesthesia (make you feel sleepy).
• Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
• The doctor makes a few tiny incisions in the chest.
• Next, your lungs will be temporarily collapsed and moved aside to allow the doctor to reach the affected area.
• The doctor inserts a thoracoscope (thin tube with a light and a camera) to assess the pleural space through a small incision.
• When the area affected is identified, the doctor will make a few small incisions to peel off the fibrous pleural layer.
• Once the pleural capsules are fully removed, the lungs are re-inflated.
• The doctor will close up the incision(s) with stitches or staples, and you will be moved to the recovery area.

What to Expect After Decortication Procedure

After the procedure, you will be taken to the step down unit for 5 to 7 days. Other recommendations include:

General Guidelines

• The breathing tube is removed when you wake up from anesthesia.
• Ambulation is started on the first or second day of surgery.
• Urine catheters and drainage tubes (chest tubes) are removed after 24 to 72 hours.
• You can probably do your normal activities after the surgery. But, you may need to take it easy at first. No heavy lifting or vigorous exercises until your body has healed.
• Receive several different medicines to relieve pain. Patients will be given long-acting oral pain medication, NSAIDS, IV pain medication and multi-level intercostal nerve blocks.
• Your doctor will give you instructions to follow during your recovery.