Decortication

Decortication is a medical procedure involving the surgical removal of the surface layer, membrane, or fibrous cover of an organ. The procedure is usually performed when the lung is covered by a thick, inelastic pleural peel restricting lung expansion. It may also be done in the treatment of chronic laryngitis. Decortication is performed under general anaesthesia. It is a major thoracic operation requiring a full thoracotomy.

Nowadays this procedure can be performed using thoracoscopy. All fibrous tissue is removed from the visceral pleural peel and pus is subsequently drained from the pleural space. In most people, the pleural space is less than 1 mm thick. When this space is violated by any number of pathological disorders, the distribution of certain cells and fluid can be altered, with serious medical consequences.

Ordinarily there is 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 mesothelioma, this space can fill which can eventually form a capsule around the lung. 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.