Decortication is a specialized thoracic surgery performed to remove a thick layer of scar tissue, infection or fibrous material from the pleural space surrounding the lungs. When inflammation, infection or chronic fluid buildup causes the lung to become trapped and unable to expand fully, decortication surgery can restore lung function, improve breathing and help patients return to normal activities.
The cardiothoracic surgery experts at Tampa General Hospital provide expert consultations, evaluations and treatment for complex pleural conditions to patients in Brooksville, Spring Hill, Crystal River and beyond. At TGH Brooksville, our surgeons perform advanced open and minimally invasive procedures designed to achieve the best possible outcomes while minimizing recovery time.
What Is Decortication?
Decortication, also known as lung decortication or pleural decortication, is a surgical procedure that removes a restrictive, abnormal layer of fibrous tissue from the thin membrane lining the lungs, chest wall and diaphragm, called the pleura. Abnormal tissue, or “pleural peel,” can develop because of infection, inflammation, bleeding or chronic fluid accumulation in the pleural space.
As scar tissue thickens, it can prevent the lung from expanding properly, leading to symptoms such as shortness of breath, chest discomfort and reduced exercise tolerance. The goal of the decortication procedure is to remove this tissue and allow the lung to re-expand fully.
When Is Decortication Surgery Recommended?
Decortication is typically recommended when less invasive treatments, such as antibiotics or drainage procedures, are no longer effective. Candidates for pleural decortication may have conditions that impair lung expansion, such as:
- Trapped lung
- Pleural infections, particularly Stage III empyema when a thick, fibrous peel forms because pus can’t drain from the lungs
- Chronic pleural fibrosis (pleural thickening and scarring) or its most severe form, fibrothorax
- Chronic pleural effusions associated with trapped lung or pleural fibrosis
- Persistent pleural scarring after infection, inflammation, trauma or radiation therapy
Patients who continue to experience symptoms despite drainage procedures or medical management may benefit from surgical evaluation.
Determining who needs decortication begins with a comprehensive evaluation. Cardiothoracic specialists use advanced imaging and diagnostic testing to assess lung function, pleural disease and the extent of lung restriction. Evaluation may include:
- CT scans to assess empyema, pleural thickening and fibrothorax
- Chest X-rays
- Thoracentesis with pleural fluid analysis
- Pulmonary function testing
- Additional imaging studies to evaluate trapped lung and lung expansion
How Is Decortication Surgery Performed?
The specific surgical approach depends on the patient's condition, the severity of pleural disease and the extent of scar tissue present. In many cases, surgeons can perform decortication using video-assisted thoracoscopic surgery (VATS), a minimally invasive technique that utilizes several small incisions in the chest. During VATS decortication, a tiny camera and specialized surgical instruments are inserted through small incisions to carefully remove infected or fibrous tissue while minimizing trauma to surrounding structures. Compared with traditional open surgery, VATS decortication may offer several advantages, including smaller incisions, less postoperative pain, reduced blood loss, shorter hospital stays and faster recovery times. Many patients with empyema or trapped lung may be candidates for this minimally invasive approach.
In more advanced or complex cases, an open thoracotomy may be necessary. This technique involves a larger incision that provides direct access to the chest cavity, allowing surgeons to safely and effectively remove extensive scar tissue and pleural thickening. Open decortication is often recommended for patients with severe fibrothorax, extensive pleural disease or advanced chronic infections that cannot be adequately treated using minimally invasive techniques. The choice between VATS and open decortication depend on the patient's unique condition and the surgeon's assessment of the most effective approach.
What Is Recovery Like After Lung Decortication?
Recovery after decortication varies depending on the extent of the procedure and the patient's overall health. Most patients remain in the hospital for monitoring and pain management following surgery. Breathing tubes and chest tubes will be in place for a period of time after surgery to help keep the lungs inflated and to drain fluid, respectively.
During recovery, patients may experience:
- Temporary soreness or discomfort
- Fatigue
- Shortness of breath that gradually improves as the lung re-expands
- The need for breathing exercises and pulmonary rehabilitation
Decortication recovery time can range from several weeks to a few months. Following postoperative instructions and participating in rehabilitation programs can help optimize healing and restore lung function.
What Are the Risks of Decortication?
As with any surgical procedure, decortication surgery carries certain risks. Potential complications may include:
- Bleeding
- Infection
- Air leaks from the lung
- Pneumonia
- Adverse reactions to anesthesia
Despite these risks, outcomes following pleural decortication are generally favorable when performed by experienced cardiothoracic surgeons. Many patients experience significant improvements in breathing capacity, lung expansion and overall quality of life.
Decortication vs. Other Treatment Options
Not all pleural conditions require surgery. Early-stage infections may respond to antibiotics and drainage procedures. However, when significant scar tissue develops and prevents normal lung expansion, surgery may be recommended.
Compared with drainage alone, decortication directly removes the restrictive tissue causing symptoms. In patients with advanced empyema or trapped lung, surgery may provide more complete and lasting relief than antibiotics or drainage procedures alone.
The decision between surgery versus antibiotics for empyema, or VATS versus open decortication, depends on each patient's unique condition and disease severity.
Take the Next Step
Patients undergoing decortication at Tampa General Hospital are cared for by an experienced team of cardiothoracic surgeons, pulmonologists, infectious disease specialists and rehabilitation professionals who work together to develop individualized treatment plans. From the initial consultation through postoperative recovery, our focus is on delivering comprehensive care that addresses each patient's condition, symptoms and long-term health goals.
As Florida’s premier academic health system affiliated with USF Health, Tampa General offers access to advanced thoracic surgical expertise, including minimally invasive VATS procedures and complex open chest operations when necessary. Patients throughout Brooksville, Spring Hill, Crystal River and surrounding communities benefit from coordinated, multidisciplinary care from our cardiothoracic surgery services team designed to support successful outcomes and improved quality of life.