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Decortication refers to a surgical procedure done to free a fibrous capsule that has formed around the lung, secondary to an inflammatory process, such as an infection. Ordinarily there is a space between the lung and the inside of the chest wall, with this space "lubricated" by a thin layer of fluid. In some conditions, such as pneumonia, or after an episode of bleeding in the chest, this space can fill with fluid which can eventually solidify and form a capsule around the lung.
This type of infection is called an “empyema”. The infected material deposited onto the lung is called a pleural peel.

Blood in the Pleura Before Decortication

As the capsule grows, it can entrap the lung and cause problems with breathing. In a decortication operation, the surgeon works to remove this capsule and free the lung so that it can function normally. Following the decortication surgery, you will have a drainage or “chest tube” left in for a few days until your lung is totally healed and stuck up to the chest wall. Our surgeons use minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) to perform
the procedure. Your surgeon will tell you if you are a candidate.

After Decortication

Patients having decortication typically stay in the hospital 5-7 days. They one to three small tubes draining fluid and air from their side. When the tube is removed, the patient can expect to go home. They usually have a PCA for pain which is transitioned to oral pain medications when the tube is removed. Patients start with a clear liquid diet and are advanced to a regular diet if they tolerate clear liquids. Patients are encouraged to be out of bed and walk as much as possible.