The lung decortication procedure involves the operative cleaning of the pulmonary structure from the fibrinous coating, which prevents the restoration of its shape. In the process of surgical intervention, cicatricial sclerotic changes in the visceral pleura are removed, which impede the full functioning of the organ. Since lung decortication was first proposed by the French surgeon Delorm, this type of intervention was called the Delorm operation.
Indications for the operation
Lung decortication is indicated for a relatively small list of diseases and as the main treatment method is used in the following cases:
- pneumopleuritis, not amenable to traditional treatment;
- fibrinothorax;
- empyema (with damage to no more than one lobe of the lung, up to six months ago);
- rigid pneumothorax, with the exception of extensive cavernous lesions;
- bronchial fistulas, etc.
Note that the Delorm operation (as an independent surgical intervention) is used infrequently. In most cases, lung decortication is successfully combined with pleurectomy, resection, or thoracoplasty.
A contraindication to surgical intervention may be an active form of the tuberculosis process, amyloidosis of internal organs, purulent intoxication, extensive cavernous processes and age restrictions. As in the cases of the indicated resection, the intervention is recommended for patients not older than 50 years.
Techniques Combined with the Delorm Operation
Pleurectomy with lung decortication 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 desolation of the cavity due to the stretching of the cavity sections, not subjected to collabation and displacement of the mediastinum, released as a result of lung decortication.
If necessary (in advanced cases), the operation is performed combined on both lungs. Often the 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 performed on the remaining part. This lung decortication is called partial.
Technical features of the operation Delorma
Modern surgeons clearly distinguish between two types of pleural operations. Interventions aimed at removing the cramping are called “lung decortication”. In case of removal of the pleural region, the term “pleurectomy” is more acceptable.
Abroad, such interventions are done under general anesthesia, like most other intrathoracic surgeries. However, the use of local anesthesia provides much better conditions, in which the surgeon has more time to separate the growths of pleural tissue from the tissues of the chest wall, often these adhesions are very strong. It is possible to use diathermy and dynamically inflate the lungs through a tight-fitting mask or with an oxygen pillow.
The method of online access, as a rule, does not differ from the methods that are used when performing resections. An exception is patients with increased chest length (about half a meter from the diaphragm to the domed pleural region). In this case, an intercostal incision is used across three to four ribs using screw retractors providing sufficient access (about 30 centimeters).
Lung decortication is an operation, the purpose of which is to straighten a deformed lung, restore organ functionality and completely eliminate the residual cavity. The operation is performed by a thoracic surgeon, most often 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 happen: bleeding, accidental damage to the lung tissue, pneumothorax.
A number of preparatory preoperative procedures allows minimizing the risk of possible complications. Multi-axis fluoroscopy and computed tomography make it possible to determine 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 organ collapse. To clean the contents of the cavity, pleural punctures 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 is carried out according to plan, and a positive result is noticeable immediately after the operation.