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dr jashwant patel
M.S,, F I A C S
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Dr. Jashvant Patel 1st nominated by : The American Biographical Institute for GREAT MINDS OF THE 21ST CENTURY

Dr. Jashvant Patel 1st nominated by : The American Biographical Institute for GREAT MINDS OF THE 21ST CENTURY

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Excision of an empyema sac and thickened pleura from the lung and chest wall has been performed for over 70 years. The most appropriate fields of application of this procedure are in treatment of tuberculous empyema, empyema complicating pneumonic processes (most frequently caused by staphylococcal infection), and clotted hemothorax following chest injury.

A pleurectomy / decortication (P/D) is an operation for that removes the involved pleura and frees the underlying lung so that it can expand and fill the pleural cavity.

The pleural space is a potential cavity between the lung and the chest wall-more specifically, between the visceral pleura and the parietal pleura. In the average healthy patient, this space is less than 1 mm thick. There are a number of pathologic processes that can alter the transport of cells and fluid within this space and thus give rise to clinically significant sequelae.
One such process is fibrothorax, which is defined as the presence of abnormal fibrous tissue within the pleural space, resulting in entrapment of the underlying pulmonary parenchyma (a state variously referred to as trapped lung, restrictive pleurisy, or encased lung).
Decortication is the surgical procedure by which this restrictive fibrous layer is peeled away from the lung; the literal meaning of the term is the stripping away of a rind. The technical goals of the operation are to re-expand the lung and resolve the pathologic process affecting the pleural space so that pulmonary function and chest wall mechanics will improve and the patient's symptoms will be relieved.
Steps in P/D Operative Technique
01. Incision and exposure of parietal pleura
02. Dissection of parietal pleura from endothoracic fascia, diaphragm, and mediastinum*
03. Incision of the parietal pleura and exposure of the visceral pleura
04. Decortication of the visceral pleura
05. Reconstruction
* May need en bloc resection of diaphragm or pericardium
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