Surgery for Pleural Diseases
Decortication & Drainage for Tubercular Empyema
Empyema thoracis is defined as a collection of pus in the pleural space (space between the lung and its lining membrane), of varying etiologies. Very often this pus is formed as a result of a complication of tuberculosis.
The patient has a fluid or pus build up around the lungs which causes the lungs to collapse. The pus gradually organises with thick septations and sometimes forms multiple pockets of collection in the pleural space. Eventually a peel develops around the lungs which further prevents re-expansion of the lung.
Dr. Sabyasachi Bal and Dr Kamran Ali along with their team have years of experience to allow parenchymal re-expansion through Video-Assisted Thoracoscopic Decortication. This surgical procedure is performed for removing restrictive layers of fibrous membrane that overlies the lung parenchyma, diaphragm and chest wall.
Decortication & Drainage for Parapneumonic Loculated Effusions
Parapneumonic Loculated Effusions are generally seen in about 20-40 percent of patients who are hospitalised with pneumonia. In the case of persistent loculated effusion, video-assisted thoracoscopic surgery is routinely recommended for breaking the loculi, drainage of effusion and decortication to help the lung expand fully.
Surgery for Hemothorax
Hemothorax is when blood collects between the chest wall and lungs. This usually happens after a blunt or penetrating chest trauma. The buildup of the volume of blood in the pleural space can eventually cause the lung to collapse as the blood pushes on the outside of the lung.
The most important treatment for hemothorax is draining the blood out of the chest cavity. We generally put a tube through the chest muscles and tissues, between the ribs, and into the chest cavity to drain any pooled blood. This is called a thoracentesis or thoracostomy.
If the bleeding continues even as the tube drains the blood, we may need chest surgery to treat the cause of the bleeding. In emergency situations an open surgery is done to control the source of bleeding. In case of old collected blood, VATS evacuation of hemothorax can also be safely done.
Surgery for Chylothorax
Chylothorax is a rare condition in which lymphatic fluid leaks into the space between the lung and chest wall. It can cause a severe cough, chest pain, difficulty breathing and nutritional deficiency. Chylothorax has many potential causes, including Injuries to the central lymphatic system due to surgery or trauma (traumatic chylothorax), Congenital lymphatic malformations such as lymphangiomatosis, Tumors, Systemic diseases or infections such as tuberculosis & Congenital syndromes such as Gorham-Stout, Noonan and Turner syndromes.
The most commonly performed surgical techniques for resolving chylothorax are ligation of the thoracic duct, pleurodesis, or a pleuroperitoneal shunt.
Surgery for Malignant Pleural Effusion – Pleurodesis
Globally, Pleurodesis is considered as the accepted palliative therapy for patients who are diagnosed with symptomatic, recurrent malignant pleural effusions. Video-assisted thoracoscopy (VATS) is regarded as an acceptable and simple procedure to control Malignant Pleural Effusions. Pleurodesis is performed for preventing re-accumulation of the effusion and the associated symptoms.
Pleurodesis can be defined as a procedure in which medications (talc powder, doxycycline etc) are used for adhering the lung to the chest wall. It is used to seal up the space between the chest wall and the outer lining of the lung for preventing air or fluid from building up continuously in the lungs.
A pleural biopsy is a surgical procedure for taking a small portion of the pleura for diagnostic purposes. It can be safely performed by a key-hole surgery (VATS)
Pleurectomy is described as a procedure for removing the lining between the chest wall and the lungs after recurrent episodes of spontaneous pneumothorax (collapsed lungs).
Spontaneous Pneumothorax, Blebs and Bullae
Primary spontaneous pneumothorax is likely due to the formation of small sacs of air (blebs) in lung tissue that rupture, causing air to leak into the pleural space. Air in the pleural space creates pressure on the lung and can lead to its collapse.Secondary pneumothorax is caused by rupture of the lung which has pre-existing disease, example emphysema.
Pulmonary bullae are, like blebs, cystic air spaces that have an imperceptible wall (less than 1 mm). The difference between blebs and bullae is generally considered to be their size, with the delimiter being either 1 or 2 cm in diameter, depending on the source. Blebs may, over time, coalesce to form bullae.
RUPTURED BLEBS WHICH LEAK AIR MAY REQUIRE vats SURGERY. Large bullae, even if they have not ruptured can compress normal lung tissue and will need removal by VATS surgery if they occupy more than half the chest cavity because they usually cause breathing difficulty.