What is decortication?
Decortication is a surgical procedure that removes the restrictive layer of fibrous tissue overlying an organ. It is mostly performed to remove the fibrous layer over the lung, chest wall, and diaphragm.
Pleura is a thin membrane that lines the outer surface of the lungs (visceral pleura) and the inner surface of the chest wall (parietal pleura). The space between these is called the pleural space. The pleural space is less than 1 mm thick and is filled with fluid.
When this space is affected by pathologic disorders, it can lead to medical consequences. One of the complications is fibrothorax, which is an abnormal accumulation of fibrous tissues (scar tissue) over visceral pleura.
Deposits of fibrous tissues over the lung can be so intense that the layers of the pleural space fuse, preventing the lung from expanding adequately. Over time, the lung becomes entrapped and breathing becomes difficult.
Decortication surgery aims to remove this fibrous layer and allow the lung to expand, decrease breathing problems and other lung symptoms. When the peel is removed, the elasticity of the chest wall returns, and the lung can expand and deflate.
Why is decortication performed?
The primary indication for decortication is fibrothorax leading to symptoms of lung restriction. Patients with fibrothorax present with difficulty in breathing which aggravates with the following:
- decreased chest wall movement,
- reduced breath sounds,
- chest discomfort,
- chest pain, especially during deep breaths, and
The conditions that cause fibrothorax are:
- Pneumonia (lung infection)
- Empyema (pleural space infection)
- Iatrogenic infection and scarring after pleural tap (infection following the diagnostic/therapeutic removal of fluid or air from the pleural space)
- Sepsis (infection in the blood)
- Hemothorax (blood accumulation in pleural space)
- Long-term exposure to chemicals (e.g. asbestos)
How is decortication performed?
Decortication is performed under general anesthesia. There are two types of decortication based on the technique. Depending upon the extent of disease, the surgeon decides which technique to choose at a given time.
- This is an open surgical procedure. The surgeon makes an incision (surgical cut) of around four inches over the chest. This technique allows the surgeon to directly view and analyze the surgical area and extent of the disease.
- The thick peel covering the lungs is exposed and removed. Remnant blood and debris present in the pleural cavity are removed to prevent infection and future scarring.
- The expansion of the lungs is checked on the table and the skin and underlying tissues are sutured (stitched).
Video-assisted thoracoscopic surgery (VATS)
- Small incisions are made on the skin above the chest cavity to insert a thoracoscope (camera with a light source) and surgical instruments.
- The peel is carefully removed piece by piece to avoid air leaks. Any remnant blood and debris are cleared.
- The underlying tissues and skin are sutured.
- After the surgical procedure, patients may experience pain, swelling, and bruising.
- The doctor may prescribe painkillers and antibiotics.
- The average stay in the hospital after VATS is two to three days and three to five days after surgery. Patients are mobile within 24 hours after surgery.
- Chest physiotherapy may be advised after surgery.
What are the complications of decortication?
The success rate of decortication surgery is high, with low morbidity and mortality rates. Like any major surgery, decortication may be associated with certain risks and complications, which are usually manageable.
Some common complications are:
- Air leak from the lung
- Broncho-pleural fistula (an abnormal connection between the pleural space and the lung)
- Respiratory failure
- Cardiac complications
- Damage to surrounding structures
Health Solutions From Our Sponsors
Top Why Is Decortication Performed Related Articles
COPD (Chronic Obstructive Pulmonary Disease)COPD or chronic obstructive pulmonary disease is a lung condition caused by smoking tobacco, exposure to secondhand smoke, and/or air pollutants. Conditions that accompany COPD include chronic bronchitis, chronic cough, and emphysema.
Symptoms of COPD include shortness of breath, wheezing, and chronic cough. Treatment of COPD includes GOLD guidelines, smoking cessation, medications, and surgery. The life expectancy of a person with COPD depends on the stage of the disease.
COPD QuizCOPD is a combination of three conditions? Take this quiz to learn the three conditions that make up the pulmonary disease called chronic obstructive pulmonary disease (COPD).
Energy Foods for COPDWhat are COPD foods to avoid that may trigger symptoms? Learn more about the COPD diet. Boost your energy and combat COPD with these diet tips.
COPD Lung SymptomsCOPD is a pulmonary disorder caused by obstructions in the airways of the lungs leading to breathing problems. Learn about COPD symptoms, diagnosis, and treatment options.
EmphysemaEmphysema is a COPD (chronic obstructive pulmonary disease) that often occurs with other obstructive pulmonary problems and chronic bronchitis. Causes of emphysema include chronic cigarette smoking, exposure to secondhand smoke, air pollution, and in the underdeveloped parts of the world. Symptoms of emphysema include chronic cough, chest discomfort, breathlessness, and wheezing. Treatments include medication and lifestyle changes.
Interstitial Lung Disease (Interstitial Pneumonia)Interstitial lung disease refers to a variety of diseased that thicken the tissue between the lungs' air sacks. Symptoms of interstitial lung disease include shortness of breath, cough, and vascular problems, and their treatment depends on the underlying cause of the tissue thickening. Causes include viruses, bacteria, tobacco smoke, environmental factors, cancer, and heart or kidney failure.
Lung CancerLung cancer kills more men and women than any other form of cancer. Eight out of 10 lung cancers are due to tobacco smoke. Lung cancers are classified as either small-cell or non-small-cell lung cancers.
Lung Cancer Myths/FactsLearn about lung cancer myths and facts. Explore how cigar smoke, menthol, and pollution can increase your risk of lung cancer and learn what to avoid.
Lung Cancer SlideshowLearn about lung cancer early warning signs, symptoms and treatments. What causes stage IV lung cancer? Get more information on small cell lung cancer, non-small cell lung cancer, and the diagnosis of lung cancer stages.
Know Your Lung Cancer Facts QuizLung cancer is the number one cause of cancer deaths in both men and women in the U.S. and worldwide. Get the facts about lung cancer with this quiz.
Lung AnatomyThe lungs are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and the blood. Eliminating carbon dioxide from the blood is important, because as it builds up in the blood, headaches, drowsiness, coma, and eventually death may occur. The air we breathe in (inhalation) is warmed, humidified, and cleaned by the nose and the lungs.
Lungs PictureThe lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax). See a picture of the Lungs and learn more about the health topic.
Small Cell Lung Cancer vs. Non-Small Cell Lung CancerNon-small cell lung cancers (NSCLC) consist of large cell carcinomas, adenocarcinomas, and squamous cell carcinomas. Small cell lung cancer (SCLC) usually starts in the bronchi and typically appears in those who smoke. SCLC and NSCLC are staged in different manners, and SCLC tends to metastasize more quickly than NSCLC. Signs and symptoms of NSCLC and SCLC include shortness of breath, coughing up blood, recurring lung infections, and chest pain. Treatment may involve radiation therapy, chemotherapy, and surgery.
Pleural Effusion (Fluid in the Pleural Space)Pleural effusion is a buildup of fluid in the chest or on the lungs. There are two types of pleural effusion, transudate and exudate. Causes of transudate pleural effusion include congestive heart failure, kidney failure, and cirrhosis. Exudate pleural effusion can be caused by malignancy (cancer) or lung infection. Typically, transudate pleural effusion is more easily treatable. Symptoms of pleural effusion include chest pain, pain when breathing, difficulty breathing, and cough. Treatment depends on the source or cause of the pleural effusion.
Collapsed Lung (Pneumothorax)A pneumothorax is free air in the chest outside the lung, that causes the lung to collapse (collapsed lung). There are two types of pneumothorax, spontaneous or primary pneumothorax and secondary pneumothorax. Symptoms include sudden chest pain, shortness of breath, rapid heart rate, rapid breathing, cough, and fatigue.
Pulmonary Embolism (Blood Clot in the Lung)A pulmonary embolism (PE) occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate. Causes of pulmonary embolism include prolonged immobilization, certain medications, smoking, cancer, pregnancy, and surgery. Pulmonary embolism can cause death if not treated promptly.
Smoker's Lung: Pathology Photo EssaySmoker's lung photo essay is a collection of pictures and microscopic slides of lung disease caused by cigarette smoking. Smoker's lung refers to the diseases and structural abnormalities in the lung caused by cigarette smoking.