Decortication of the lung.

From 1972 to 1982, 161 patients underwent pleural decortication because of pleural callosity with or without empyemic residual cavities. Indications were: Sanitation of infection sites and improvement of respiratory function. Of the patients, 73.3% had non-specific and 22.4% tubercular empyema. Postoperative complications included 8.7% wound infections and 1.2% recurring empyema. Operative mortality was 1.2%. To estimate pulmonary function, the preoperative values of blood gas analysis, vital capacity, forced expiratory volume and maximal voluntary ventilation were assessed and compared with those obtained early postoperatively and after one year in 75 patients. The average values of these measurements showed no significant improvement in postoperative pulmonary function. A relatively slight improvement (mean 13.8%) showed only in those patients who had a preoperative reduction of vital capacity of more than 40%. The indication for decortication to improve pulmonary function alone is questionable. As a rule it is based upon 2 factors--both elimination of infectious foci and improving function.