Surgical decortication is a procedure used to treat pleural empyema, (a condition where pus accumulates in the
pleural space surrounding the lungs) often as a complication of pneumonia. The main goal of decortication is to
remove this pus, fibrous tissue, and infected or inflamed pleura, thereby allowing the lung to re-expand and function
properly.
Pleural empyema can be classified into three stages:
1. Exudative Stage.
2. Fibrinopurulent Stage.
3. Organising Stage.
In the early exudative stage, the focus is usually on antibiotics and drainage. However, when the condition
progresses to the fibrinopurulent or organizing stages, with thickening of the pleura and formation of fibrous tissue,
surgical intervention may become necessary.
Decortication involves the surgical removal of the thickened pleura and fibrous layers that restrict lung expansion.
This procedure can be performed either through traditional open thoracotomy or via video-assisted thoracoscopic
surgery (VATS). VATS is generally preferred due to its minimally invasive nature, leading to quicker recovery times
and less post-operative pain compared to open thoracotomy. However, the choice of technique depends on the
patient's condition, the stage of empyema, and the surgeon's expertise.
The procedure starts with accessing the pleural space either through small incisions (in VATS) or a larger incision (in
open thoracotomy). The surgeon then meticulously separates and removes the thickened pleural layers from the
lung surface. This process allows the lung to re-expand and improves respiratory function.
Post-operative care is crucial for recovery. It includes pain management, respiratory therapy, and monitoring for
complications like bleeding or infection. Patients may need a chest drain post-surgery to remove air or fluid until the
lung re-expands completely and heals.
Successful decortication improves lung function and quality of life. The prognosis is generally good, especially when
the surgery is performed in the appropriate stage of empyema and is followed by adequate post-operative care.