Decortications

Decortication is the removal of a thickening pleura (a fibrous capsule that forms around the lung in reaction to inflammation) from the surface of the lung and the inside of the chest wall. It is particularly helpful in lung surgery when the thick, inelastic layer constricts lung expansion. Effusion happens when fluid accumulates between the layers of pleura, filling the space and restricting the lung’s ability to breathe and move freely within the chest cavity.

Pleural effusions are not uncommon, especially as the body ages. It can be caused by congestive heart failure, cirrhosis (liver disease), end-stage renal disease, or cancer. Illnesses such as pneumonia, lupus or other autoimmune disease, as well as an unexpected pulmonary embolism can also create the condition.

Top Heart, Thoracic Surgeons in Florida

Small pleural effusions reveal few symptoms, but as the condition worsens, a patient may experience chest pain, especially on breathing in deeply (pleurisy, or pleuritic pain). Fever, cough and shortness of breath are other symptoms that should not be ignored. Most often, pleural effusions are discovered on imaging tests either through chest x-ray film, computed tomography (CT scan), or ultrasound.

Surgery is done under general anesthesia. Tubes are placed in the lumen and the lung is gently freed from the chest wall. A thoracoport is introduced, and endoscopic inspection of the cavity is performed. Loculations and fibrin deposits within the chest cavity are removed and decortication by use of an endoscopic lung dissector or scissors is then performed. The cavity is then rinsed and the lung is inflated at the end of the procedure.

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Proper dissection of the plane between the thick membrane and the lung surface requires pinpoint accuracy and decades of experience to know the exact amount of pressure to use when determining exact positioning of incision. Careless handling of soft tissues can create poor wound closure. The delicate surgery demands the best thoracic surgeons in Florida. You’ll find them at the Ocala Heart Institute.

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