Decortication

Decortication is a surgical procedure that removes a restrictive layer of fibrous tissue overlying the lung, chest wall, and diaphragm. Decortication aims to remove this layer and allow the lung to re-expand. When the peel is removed, compliance in the chest wall returns, the lung can expand and deflate, and patient symptoms improve rapidly.

In most people, the pleural space is less than 1 mm thick. When any number of pathologic disorders violates this space, the distribution of specific cells and fluid can be altered, with serious medical consequences

Decortication is performed under general anesthesia. It is a major thoracic operation that has traditionally required a full thoracotomy. Since the early '90s, this procedure has increasingly been performed using more minimally invasive thoracoscopy. All fibrous tissue is removed from the visceral pleural peel and pus is subsequently drained from the pleural space.

Other than the overall health of the patients, there are no absolute contraindications. In some lung-disease patients, the lung will not expand after removal of the pleural peel, rendering the surgery futile. Other diseases that render decortication futile are narrowing of the significant airway stenosis and uncontrolled pleural infection. With these conditions, the lung will not expand to fill the thorax space. A major surgery called a pleuropneumonectomy can be the only available option, but only if the patient has been worked up before the surgery. Pleuropneumonectomy is a significant surgery with very high mortality and high invasiveness.