What is Pleural Surgery?

The lungs are surrounded by two membranes, together called the pleura. One layer lies close to the lung; the other coats the inside of the chest wall. As a healthy person breathes, these two layers slide across each other, protecting the lungs while allowing the movement of inhalation and exhalation. Sometimes, the pleura become diseased and require surgery. Pleural surgery is almost always used in the treatment of a type of lung cancer called mesothelioma, but it can also be used to treat conditions such as pleurisy (inflammation of the pleura) or empyema (pus accumulation).

There are several different kinds of pleural surgery. Some of the more common ones include pleurectomy, decortication, extrapleural pneumonectomy, and pleurodesis.

Pleurectomy is the removal of the membrane that lines the chest wall, and decortication is the removal of the membrane that lines the lung. Often, the two procedures are performed together to treat mesothelioma. In a pleurectomy/decortication (P/D) procedure, both pleura are removed along with any visible tumors. Sometimes the walls of the lung are scraped to remove as many cancer cells as possible.

Extrapleural pneumonectomy, or EPP, is used in severe cases where much of the pleura and lung are diseased. It involves the removal of the entire affected lung along with the pleura, the pericardium (membrane around the heart), and part or all of the diaphragm. The diaphragm and pericardium are usually reconstructed and replaced.

Pleurodesis is a treatment used for mesothelioma and some other pleural diseases, where fluid builds up in the space between the two membranes. The fluid puts pressure on the lungs, making it harder to breathe. During pleurodesis, any excess fluid is removed and then an irritant, usually talc, is spread over the surface of the pleura. The resulting irritation makes the membranes sticky, and they fuse together. This prevents fluid from building up between the pleura again. In some cases, a related surgery called pleural abrasion is used. The idea is the same, but instead of talc, the surgeon rubs the surface of the membrane to irritate it.

Depending on the specific surgery performed, the procedure may be done through an incision across the side of the chest (thoracotomy) or under the breastbone (sternotomy). Some procedures can be performed through a kind of minimally invasive surgery called video-assisted thoracoscopic surgery or VATS. VATS uses several smaller incisions, tiny instruments, and a small camera to guide the surgeon.

Most pleural surgeries take several hours to perform. Afterwards, patients will typically need to stay in the hospital for a few days to a week. Breathing exercises are an important part of healing, as they stretch the lungs and muscles of the chest and help to remove any excess fluid. Full recovery from pleural surgery may take a month or more.

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