Lung diseases are disorders or infections that affect the lungs and cause breathing problems, thus sometimes leading to respiratory failure. One such lung disease is chronic empyema. Empyema is also called pyothorax or purulent pleuritis. It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. Chronic plueral empyema can be treated by decortication. The decortication surgery is done in the thoracic region to remove a fibrous tissue that abnormally forms and grows on the surface of the lung, chest wall or diaphragm. The main motive is to remove this restrictive tissue layer that covers the lungs to allow them to re-expand and function normally.
Dr. Arun Kanala is an expert decortication surgeon at Al Zahra Cancer Center in Dubai. He is a board certified thoracic surgeon with a surgical experience of more than 20 years and is also an expert in conducting lung cancer surgeries, tracheal resection surgeries, chest wall surgeries, and minimally invasive procedures – VATS (Video-Assisted Thoracoscopic Surgery).
Between the lungs and the chest wall, there is a pleural space which is lined with a very thin fluid layer called lubrication. This area is moist thus allowing the lungs to expand and contract smoothly when breathing. But certain diseases such as pneumonia, infection or bleeding can lead to accumulation of excess fluid in this gap. In the long run, this excess fluid can become solid and form a fibrous capsule that restricts the lung and entraps it, causing breathing problems.
Who Should Undergo Decortication and Its Results Thereof
Decortication is the best suitable treatment for all the patients suffering from complex empyema. It is a condition that mimics the symptoms of pneumonia such as fever, shortness of breath, dry cough, and chest pain. With time and treatment of pneumonia does not improve, it leads to empyema.
If in case, the symptoms of the pleural peel last for more than 4-6 weeks, decortication should immediately be performed. Other symptoms of complex empyema that need prompt medical intervention include:
- Difficult and decreased breathing
- High fever & abnormal weight loss
- Chest pain (usually sudden and sharp)
These symptoms occur when the empyema worsens. If the inflammation becomes severe, it results in a scar tissue thus causing the chest cavity to become divided into small cavities which are more difficult to treat. If left unattended, the pleural peel will prevent the lungs from expanding, which can sometimes be fatal. Moreover, empyema can worsen into life-threatening complications such as sepsis.
Empyema can be diagnosed and the presence of pleural peels can be determined through chest X-Rays, ultrasound, and CT Scans. Blood tests may also be conducted to identify the cause of infection. While in other case, the fluid sample is extracted using a needle for further analysis through a procedure called thoracentesis.
How Is The Procedure Performed
General anaesthesia is given to conduct decortication. In severe cases, the full thoracotomy is conducted where an incision is made into the pleural space of the chest to access the pleural peel and surgically remove it from the surface of the lungs.
Decortication through full thoracotomy is a major thoracic surgical procedure and is very complicated to do. On the chest wall, a five or six inch incision is made, through which the pleural peel is accessed and the infection is removed. To drain the blood, the drainage tubes are placed which are removed after 4-7 days.
Modern techniques such as VATS can also be performed if empyema is detected at an early stage. This procedure is less invasive and involves the use of an endoscope to visually examine the lungs and pleural structures. In the procedure, a thin tube is inserted through the mouth into the lungs. Small incisions are then made into the chest to insert drainage tubes that drain out blood during the procedure.
Once the empyema is confirmed, the surgeon inserts surgical instruments and makes several small incisions to peel off the fibrous pleural peel layer. Once the pleural capsules are fully removed, the lungs are re-inflated and the incisions are closed with sutures or staples. The entire procedure takes about an hour or two to complete.
Post procedure, the patients are usually hospitalised for a day or two so that they can properly heal and lungs restore the proper functioning. The patient has to regularly take antibiotics and pain medications for several days. Follow-up check-ups and X-rays will be required after a certain period to ensure that the pleura has properly healed.
Al Zahara Hospital in Dubai is backed by latest radiology, laboratory and diagnostic facilities, thus providing both in-patient and out-patient with treatment of international standards. We provide superior quality healthcare both at primary and specialty levels for patients’ safety and well-being.