decortication

Decortication is the surgical removal of an outer covering or rind from an organ, tissue, or plant material. The term comes from the Latin decorticare, meaning to strip the bark. In medicine, decortication most often refers to removing a fibrous peel that constricts a lung or other pleural structures, but the word can also describe similar peeling or stripping procedures in other contexts.

In thoracic surgery, pulmonary or pleural decortication aims to remove the thick, inelastic fibrous layer that forms around the lung in conditions such as empyema, organized pleural effusions, or fibrothorax. By removing this restrictive peel, the lung is able to re-expand and function more effectively. Decortication can be performed via open thoracotomy or with video-assisted thoracoscopic surgery (VATS). The choice of approach depends on disease extent, patient condition, and surgeon experience.

Outcomes vary with the underlying disease and the degree of lung recovery. Benefits can include improved ventilation, reduced chest symptoms, and better quality of life. Risks include bleeding, air leaks, infection, prolonged chest tube drainage, and respiratory complications. Some cases may require conversion from minimally invasive methods to open surgery, and recovery depends on overall lung reserve and comorbidities.

Other uses of the term exist in non-thoracic contexts, where decortication denotes removal of an outer layer or cortex to relieve restriction or enable growth, but the thoracic procedure remains the most widely recognized form. In empyema management, decortication is one option alongside medical therapy and less invasive drainage techniques.