Decortication is a video-assisted thoracic surgery (VATS) procedure done to remove a layer of fibrous tissue that has formed around a lung. An infection, pneumonia, fibrothorax or mesothelioma are the most common causes of this coating. The encapsulating tissue restricts lung function, encroaching on the space that should exist between the lung and the chest wall. A thin layer of fluid should separate those, but a condition such as pneumonia can fill that space with excess fluid that may solidify not only around the lung, but also over the diaphragm and inner chest wall. If the fibrous layer becomes too thick, the lung can be prevented from expanding.
VATS is performed through several small incisions rather than through a larger thoracotomy incision. However, sometimes the surgeon may need to switch techniques during the operation, if the infection is worse than expected, or if it isn’t possible to free the lung from its fibrous capsule. Generally, a VATS procedure has superior results: less pain, less scarring and shorter recovery time.
The aim of the decortication procedure is to peel away the overlay of fibrous tissue so that the lung can breathe properly, and to remove any tumors growing inside the chest cavity. The procedure may be necessary when:
- The tissue has been present for more than four to six weeks
- Lung symptoms are disabling
- Radiology shows a trapped lung
- Other interventions, such as a chest tube or drugs, have not cleared the infection or hemothorax; decortication may be considered after long-term drug therapy fails
Not all patients are candidates for decortication. This surgery usually has a successful outcome in young people, who may feel relief from symptoms not long after surgery. Those with comorbidities (other related conditions) are at greater risk. For elderly patients, especially those with multiple comorbidities, recovery is slower, but they are relieved of symptoms. However, because decortication is a substantial operation with some blood loss, patients must be physically fit enough to have the procedure.
The best results are obtained with early treatment. Most patients will be able to return to their previous level of exercise and back to their normal lives.