The lung decortication procedure involves the prompt cleaning of the lung structure from fibrinous coating, which prevents the restoration of its shape. During the surgical intervention, cicatricial sclerotic changes in the visceral pleura are removed, which impede the full functioning of the organ. Since decortication of the lung was first proposed by the French surgeon Delorme, this kind of intervention was called the Delorme operation.
Indications for surgery
Lung decortication is indicated for a relatively small list of diseases and as the main method of treatment is used in the following cases:
- pneumopleuritis not amenable to conventional treatment;
- fibrinothoraxes;
- empyema (when no more than one lobe of the lung is affected, up to six months ago);
- rigid pneumothorax, except for extensive cavernousdefeats;
- bronchial fistulas, etc.
Note that the Delorme operation (as an independent surgical intervention) is used infrequently. In most cases decortication of the lung is successfully combined with pleurectomy, resection or thoracoplasty.
An active form of the tuberculosis process, amyloidosis of internal organs, purulent intoxications, extensive cavernous processes and age restrictions can become a contraindication to surgical intervention. As in cases of indicated resection, the intervention is recommended for patients under 50 years of age.
Techniques combined with the Delorme operation
Pleurectomy with decortication of the lung is used in advanced cases. With this kind of intervention, in addition to decortication, the surgeon removes the parietal pleura, which forms the outer wall of the purulent cavities. This achieves the emptying of the cavity due to the stretching of the abdominal areas that are not subjected to collapse and the displacement of the mediastinum, released as a result of decortication of the lung.
If necessary (in advanced cases), the operation is performed in combination on both lungs. Often, decortication of the right lung is combined with resective interventions in the left and vice versa, since a limited lesion of one organ does not interfere with surgical intervention and further recovery. Even with resection of the operated lung, decortication can be carried out on the remaining part. This lung decortication is called partial decortication.
Technicalfeatures of the Delorme operation
Modern surgeons clearly distinguish between two types of pleural operations. Interventions aimed at removing the constricting coating are called “decortication of the lung”. In the case of removal of the entire pleural region, the term "pleurectomy" is more acceptable.
Abroad, such interventions are done under general anesthesia, like most other intrathoracic operations. However, much better conditions are provided by the use of local anesthesia, in which the surgeon has more time to separate the adhesions of the pleural tissue from the tissues of the chest wall, these adhesions are often very strong. It is possible to use diathermy and dynamically inflate the lungs through a tight-fitting mask or with an oxygen bag.
The method of online access, as a rule, does not differ from the methods used during resections. The exception is patients with an increased length of the chest (about half a meter from the diaphragm to the domed pleural region). In this case, an intercostal incision is used across three or four ribs using screw retractors that provide sufficient access (about 30 centimeters).
Decortication of the lung is an operation, the purpose of which is to straighten the deformed lung, restore the functionality of the organ and completely eliminate the residual cavity. The operation is performed by a thoracic surgeon, most often as planned.
Possible complications after surgery
The most common postoperative complications are typical of any intrathoracic intervention. The surgical process is complex and painstaking, so sometimes unplanned situations occur: bleeding, accidental damage to lung tissue, pneumothorax.
Minimize the risk of possible complications allows a number of preparatory preoperative procedures. Multiaxial fluoroscopy and computed tomography allow to determine the clear boundaries of lesions, the degree of freedom of the diaphragm and intercostal mobility, the presence of fluid in the pleural cavity and the degree of collapse of the organ. To clean the contents of the cavity, punctures of the pleura are performed, followed by disinfection with antiseptic solutions and antibiotics.
Conclusion
In conclusion, we note that with proper preoperative examination and preparation, in most patients, surgical intervention goes according to plan, and a positive result is noticeable immediately after the operation.
