Jennifer Schwartz, MD, is a board-certified surgeon and assistant professor of surgery at Yale University School of Medicine.

Pleuroplasty is an operation used to remove part of the pleura, which is the two thin layers of tissue surrounding the lungs. Pleuroplasty is most commonly used to prevent pleural effusion (fluid accumulating in the space between the pleura), to help the lungs reinflate after a pneumothorax (collapsed), or to treat pleural mesothelioma, a cancer that affects the pleura.

Pleuroplasty is a type of surgery used to treat certain diseases that damage the pleura and affect the lungs. The pleura is composed of parietal pleura (closest to the chest wall), visceral pleura (closest to the lungs), and pleural cavity (the space filled with fluid between the layers).

Depending on the condition being treated, there are different methods of pleuriectomy.

Common situations to avoid pleuriectomy include:

If pleuriectomy is used to treat malignant (cancerous) conditions, possible contraindications include:

All operations have risks of injury and complications. The most common related to pleurectomy include:

If a blood clot causes lung tissue to stick to the chest wall and form adhesions, postoperative pain and difficulty breathing may occur. Removal of existing adhesions can lead to complications of bleeding and air leakage.

When appropriate, minimally invasive VATS surgery can reduce some of these risks.

2% to 5% of people undergoing pleuriectomy will have a pneumothorax recurrence, usually within six months.

In most cases, when other less invasive procedures have failed, pleurectomy is recommended. The only exception is early mesothelioma. If the cancer can be completely removed, it is sometimes used for first-line treatment.

The four common indications for pleuriectomy are:

Pleuroplasty is usually well tolerated by people who need surgery, even children. For people with benign conditions, a pleurectomy may be required to completely solve the problem.

For patients with mesothelioma, pleuriectomy can sometimes cure the early disease. Even if there is no cure, surgery can prolong survival and improve the quality of life as part of palliative care.

Depending on the condition being treated, your healthcare provider will arrange tests to help determine the severity of your disease and choose the most suitable surgical procedure for you.

In addition, your healthcare provider will need to ensure that you are suitable for surgery based on your age, overall health, and the type of surgery you are undergoing.

Preoperative examinations for thoracic (chest) surgery may include:

If the preoperative examination shows that you can benefit from the surgery, you will meet with your surgeon to review recommendations, ask questions, and schedule your surgery.

Pleuroplasty is an inpatient operation that requires hospitalization. Preparations can vary according to the type of surgery performed and the disease being treated.

If you are not sure why you chose a certain surgical procedure, such as thoracotomy and VATS, please do not hesitate to ask your surgeon why this technique was chosen for you.

The pleurectomy is performed in the operating room of the hospital. The room will be equipped with an electrocardiogram (ECG) machine, anesthesia machine, ventilator, and a fiber-optic thoracoscope with video monitor for VATS surgery.

During your surgery, you will be asked to change into hospital gowns, so it doesn’t matter what you wear during the surgery.

You are not allowed to eat solid foods or drinks after midnight the night before your surgery.

Your healthcare provider may recommend that you stop taking certain medications that can cause bleeding. Some need to be stopped or replaced two weeks before the operation.

Always tell your healthcare provider about any and all medicines you are taking, whether they are prescription, over-the-counter, nutritional, herbal, or recreational drugs.

You need to bring a government ID and health insurance card.

Bring only what you need for your stay, which may include toiletries, mobile phones and chargers, extra underwear, comfortable robes and slippers, and home clothes. Leave valuables (such as jewelry) at home.

In addition, bring any medications you regularly take, preferably in the original bottle with a prescription label.

You also need to arrange for someone to take you home when you leave the hospital. Even minimally invasive VATS surgery can cause restricted movement and impair your ability to drive.

Regardless of the condition being treated, health care providers usually recommend that you quit smoking before a pleurectomy. Smoking can complicate lung diseases and slow down recovery after surgery. Most healthcare providers recommend that you quit smoking two to four weeks before chest surgery. If needed, smoking cessation aids can be prescribed.

For patients with mesothelioma or malignant pleural effusion, smoking cessation can increase the response rate to cancer treatment and have a positive impact on survival time.

To help with recovery, preoperative pulmonary rehabilitation may be recommended. If possible, this usually involves walking two to three miles a day and using a motivational spirometer to force you to breathe slowly and deeply to help strengthen your lungs.

Thoracoscopy is a major operation that requires general anesthesia. Depending on the purpose of the operation, the operation usually takes two to four hours.

Your surgical team will be led by a thoracic surgeon and accompanied by an anesthesiologist, an operating room nurse, an anesthesia nurse and a circulation nurse. Surgical oncologists who specialize in cancer surgery are also qualified to perform pleuriectomy.

On the day of surgery, you need to bathe with surgical disinfectant and avoid any perfume, cream, deodorant or cosmetics. Even if you are not particularly hairy, the surgical site may need to be shaved. (Don't do this yourself; a nurse will be assigned to complete this task.)

Your nurse will also perform some preoperative procedures and do some preparations. These include:

Before the operation, your anesthesiologist will visit you to carefully check your drug allergies and check for any adverse reactions that you may have had in the past.

Once your anesthetic medicine puts you to sleep, an endotracheal tube is placed in your throat to deliver oxygen and anesthesia.

You will lie on your side for easier access to the surgical site.

Depending on your surgical method, you will make a long incision in your chest to open the ribs (open thoracotomy), or make a smaller "keyhole" incision between the ribs without unfolding them (VATS).

After entering the chest, your surgeon will carefully peel and remove one or more layers of the pleura. Excess liquid can be discharged by vacuuming. If mesothelioma is involved, other tissues or tumors can be removed.

Before closing the incision, place a drainage tube to help drain blood or fluid from the chest cavity. The incision is then closed, usually using dissolving sutures that do not require physical removal.

After the operation, you will be pushed into the post-anaesthesia care unit (PACU), where you will be monitored until you wake up from the anesthesia. In most cases, you will be taken to an operating room with a monitor, and rarely to an intensive care unit (ICU).

Blood transfusions are often required, especially if thoracotomy has been performed.

In the morning or earlier after the operation, you will start walking around to prevent clots and adhesions from forming. You will begin deep breathing exercises to help your lungs expand, usually with the help of a stimulus spirometer. Prescribe painkillers to help control postoperative pain.

In most cases, the chest tube will be removed during your hospital stay. The length of your hospital stay and the degree of postoperative monitoring depend on the purpose and scope of the surgery.

Unless there are any complications, most people can be discharged from the hospital within one week after undergoing a pleurectomy. Some people may be discharged earlier, while those with serious illnesses may take longer.

The recovery after a pleurectomy may vary depending on your general health before the operation and the scope of the operation. This period usually lasts about four weeks and may involve a structured rehabilitation plan and follow-up with your surgeon.

Some people, especially those who have undergone VATS surgery, may return to work in a few weeks or less (albeit with limited capacity).

After you are discharged from the hospital, you will undergo a pulmonary rehabilitation program to restore your lung function and overall health. This may be guided by a physical therapist trained in lung diseases.

Within a few days after you leave the hospital, you need to keep the surgical wound clean and dry, and change the dressing frequently as directed by your healthcare provider or nurse.

You also need to avoid strenuous physical activity or lifting any weight that exceeds 5 to 10 pounds, unless your healthcare provider tells you otherwise.

If you experience any of the following conditions after a pleuraectomy, please call your surgeon immediately:

Managing postoperative pain is one of the biggest immediate challenges after pleuriectomy, and healthcare providers are more careful than ever to avoid excessive use of addictive opioids.

In most cases, 500 to 1,000 milligrams (mg) of Tylenol (acetaminophen) is recommended every six hours, as needed. Non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen can also be used in combination (or alternately) with Tylenol at low doses. Avoid using higher NSAID doses because they may promote bleeding.

People who have undergone extensive surgery may need more powerful short-acting opioids, such as hydrocodone (5 to 10 mg every six hours) or oxycodone (5 mg every four hours). Even so, health care providers are reluctant to prescribe these drugs for more than three days due to the risk of dependence.

Pain can also be controlled by non-pharmacological therapies, such as meditation, cold therapy, and progressive muscle relaxation.

After staying at home for a few days, you will see your surgeon for follow-up visits. Usually a chest X-ray or other imaging tests are performed in advance to determine the effect of the operation and check for postoperative complications.

You can also perform lung function tests so that your healthcare provider can monitor your lung function after surgery.

Depending on your condition, a pulmonologist who specializes in lung disease or a medical oncologist who specializes in cancer treatment may be arranged for additional visits. If pleuraectomy is used to treat mesothelioma, a course of chemotherapy and/or radiotherapy is usually given after the operation.

The most important lifestyle adjustment after pleuraectomy is to quit smoking, because smoking increases the risk of cancer recurrence, pneumothorax recurrence, and pleural effusion recurrence.

According to the Affordable Care Act, there are many smoking cessation aids that are classified as Basic Health Benefits (EHB). Even if you try to quit smoking multiple times, they are fully covered by insurance. By working with a healthcare provider or therapist and/or joining a support group, your chances of quitting smoking can increase.

It is important to embrace other healthy lifestyles, including reducing alcohol intake and weight loss when obese. Both of these conditions can lead to recurrent pleural effusion and pneumothorax.

A pleurectomy is a major operation that can have a major impact on your quality of life. Most people who undergo a pleuriectomy will fully recover. It is important to take the necessary preparation and recovery steps so that you can maximize the benefits of this process.

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