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Decortication - What Is Decortication, Why And When Is It Performed and Concerns.

A Simplified Outlook At The Surgical Procedure

In the human body, certain organs like the lungs have an outer layer of cells that can be peeled using an accurate surgical procedure. This peeling is often deemed necessary in cases where a patient suffers from conditions like tuberculosis or cancerous form called mesothelioma. The surgical procedure in question here is medically termed as Decortication.  

Understanding Decortication And Its Types

You may associate the term ‘rind’ or ‘peel’ with the skin of fruits like oranges, lemons etc. However, certain conditions that arise in our body especially occurring in and around the thoracic cavity (the hollow in your chest mainly between the lungs) can only be mitigated by removing the outer layers of tissues that surround the organ. This surgical procedure is known as Decortication. The procedure has been around since the 20th century and has been used for lessening the pain caused by an infection on the outer layer of an organ.

As such, decortication is generally applied on the lungs to manage specific pulmonary (relating to the lungs) conditions. However, this procedure of removing the surface layer is also done on other organs such as the brain, kidneys, and is generally used as palliating measure to manage the spread of cancerous outgrowth.

What Is Decortication Of the Lung?

This is one of the most common forms of decortication. It is generally performed to remove outer tissue layers of the lungs that have become fibrous, thus obstructing the organ from expanding in size to take up more air. Before beginning the procedure, the patient is first placed under general anaesthesia. Then his/her chest cavity is opened up. The surgeon goes on to identify areas in the pleural membrane that have accumulated fibrous deposits and peel them off.

Upon successfully removing the scarred rind, the chest cavity is closed and patient is brought back to consciousness. As is evident from the above explanation, decortication of the lung is quite an invasive procedure and therefore requires hefty post surgery monitoring to ensure that the patient is recovering well.        

Why And When Is Decortication Of The Lung Performed?

The space between the two lungs going all the way till the inner walls of the chest is relatively empty, with only two outer membranes (called pleura) encompassing a fluid, present there. This space is necessary for the lungs to expand when they take in air. The pleura fluid on the other hand provides the lungs with a natural cushion. The pleural membranes are slippery in nature which helps them to slide against each other when you breathe.

Bronchi, bronchial tree, and lungs.
Bronchi, bronchial tree, and lungs. (Photo credit: Wikipedia)
However when they become thick owing to fibrous formation or inflammation, it causes a lot of pain during breathing. As such, lung decortication is performed to remove the uppermost layers of the pleura and thus address the immediate problem regarding breathing difficulty. The same procedure can be applied to the outer pleural sheath covering the chest cavity in case of a bacterial infection or pneumonia. These conditions not only make the pleural sheath rigid but also fill the cavity with bacterial fluid.
Care And Concerns Regarding Decortication Procedure

It is important to understand the nature of the surgical procedure that is Decortication. Unlike other surgeries that treat a condition, decortication provides more of a palliative care, in that it only addresses the immediate concerns and therefore cannot be considered as a conclusive solution.

Furthermore, complications can arise out of the procedure. For instance, patients who have just undergone a decortication procedure and are also on prophylactic medication (drugs administered to maintain health and prevent spread of a disease) stand the risk of infection at the site of operation. Therefore, irrespective of the decortication surgery, it is your responsibility as a patient to understand both the benefits as well as risks concerned.

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