What is Decortication?

Mary McMahon

Decortication is a term which is used to refer to the removal of a rind or peel. In a medical context, the term means removing the fibrous outer layer of tissue which covers an organ. Most typically, decortication is used in the management of certain lung conditions, most notably in tuberculosis and mesothelioma. People have been using this technique since the 20th century, and it is important to note that it is a palliative measure, not a treatment or cure.

Decortication require patients be sedated with general anesthesia.
Decortication require patients be sedated with general anesthesia.

In decortication of the lung, the most common form of this procedure, the patient is placed under general anesthesia and the chest cavity is opened. The surgeon identifies areas of the pleural membrane which have become fibrous and scarred, and removes them. Then, the surgical site is closed and the patient is brought out of anesthesia. This surgery is major and quite invasive, and requires several days of monitoring in the hospital after the surgery is complete to confirm that a patient is healing well.

Prior to decortication, patients should discuss the procedure with their physician.
Prior to decortication, patients should discuss the procedure with their physician.

Lung decortication is commonly performed because thickening of the pleura is causing pain or discomfort for the patient. If the thickening progresses enough, it can lead to difficulty breathing, because the involved lung may have difficulty reinflating since it cannot push the pleura out of the way. This can lead to shortness of breath and a cascade of other medical issues as the patient struggles with lack of oxygen.

Thickening of the pleura can cause shortness of breath.
Thickening of the pleura can cause shortness of breath.

This procedure may be recommended to increase patient comfort or to address immediate breathing problems. In the long term, measures need to be taken to address the reason that the membrane thickened in the first place. In cases of cancer, for example, radiation can be used to shrink the tumor, and if it is feasible to do so, a surgeon can remove the growth of rogue cells. It is important to address the underlying cause once the patient has been made comfortable.

Decortication can be used as a palliative measure for patients suffering from terminal lung conditions.
Decortication can be used as a palliative measure for patients suffering from terminal lung conditions.

Decortication surgery is not a procedure to take lightly. Patients should discuss the reasons that the surgery is being recommended with their physicians, and they should make sure that they understand the potential benefits and risks. It is also advisable to ask about aftercare instructions, including those related to the use of prophylactic medications to prevent infections. Something to consider for patients who are terminal and are thinking about focusing on palliative care is whether or not they want to go through the surgery, given their conditions. Each case is different, and a doctor can provide information and advice specific to unique circumstances.

Lung decortication may lead to breathing difficulties.
Lung decortication may lead to breathing difficulties.
In lung decortication, the surgeon removes fibrous and scarred areas of the pleural membranes of the lungs.
In lung decortication, the surgeon removes fibrous and scarred areas of the pleural membranes of the lungs.
Decortication is commonly used to offer some relief to tuberculosis patients.
Decortication is commonly used to offer some relief to tuberculosis patients.

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Discussion Comments

anon971006

What happens after the decortitation? Does the pleura grow back? What are the after effects to the body?

anon215392

In cases where the patient is quite young, this surgery is probably a good idea to improve their quality of life and possibly help with the number of hospitalizations where they require chest tubes to expand the lung that has collapsed from empyema.

sweetPeas

@Clairdelune - My sister works as a nurse in a hospital. She has worked with a couple of patients with mesothelioma - a very serious lung disease often caused by prolonged exposure to environmental toxins.

These patients suffer greatly from pain and breathing difficulties. When mesothelioma patients become terminal, they and their families usually opt for going into palliative care. Because they are so drained, they don't want to go through a surgery. They just want to be treated for pain and breathing assistance and be at peace.

Clairdelune

I think that the decision to have a decortication surgery would be a difficult one. In cases where parts of the lungs are covered with scar tissue and the patient has a lot of trouble breathing, it would be a good idea to have surgery.

But if they have a disease like cancer or mesothelioma, and everything possible had been done to cure them, maybe surgery would be too taxing. Another kind of pain medicine could help with the pain. The patient and his/her family would be the ones to make that decision.

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