Lung Decortication

Excerpt

There are approximately 1 million patients hospitalized in the United States each year with pneumonia. Of those hospitalized for pneumonia, 20% to 40% will develop a parapneumonic effusion, and 5% to 10% of these parapneumonic effusions will progress to an empyema (approximately 32,000 patients per year in the United States). Approximately 15% of these patients with empyema die, and 30% require an operation in their chest to clear the infection. Lung decortication is a well-known procedure that was first performed by Delorme for the treatment of empyema in 1895.

It is primarily indicated in cases of chronic empyema thoracis (pyogenic or tubercular), hemothorax, pleural thickening, etc. It involves the excision of the restrictive layer of the thick fibrinous peel overlying the lung, chest wall, and diaphragm. This thick fibrinous peel is a result of the ingrowth of the fibroblasts during the advanced stages of empyema. Apart from its proven utility in advanced stages of empyema, favorable outcomes have been revealed by Shin et al. when decortication was adopted as the first-line treatment for empyema. The main aims of this surgical procedure are the restoration of lung expansion, removing the source of infection, and prevention of deformity due to fibrothorax.