Stages of empyema

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Empyema typically progresses in 3 stages:

• Stage I: Treated with antibiotics and drainage

• Stage II: May require VATS decortication or fibrinolytic therapy

• Stage III: Often requires surgical decortication (sometimes open surgery)

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Why choose VATS lung decortication?

• Small incisions (≈1 cm)

• Less postoperative pain

• Faster recovery

• Shorter hospital stay

• Lower complication rates

• Better lung expansion and function

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 How is the procedure performed?

• Performed under general anesthesia

• Small incisions are made in the chest

• A camera (thoracoscope) is inserted

• Surgical instruments are used to remove the fibrous layer

• A chest tube is placed temporarily

The procedure usually takes 2–4 hours, depending on the severity of the condition.

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Before surgery

Patients may require:

• CT scan (essential for diagnosis and staging)

• Blood tests

• Lung function tests

• ECG

After surgery

• Hospital stay: typically 3–7 days

• Chest tube for drainage

• Pain is usually mild to moderate

• Breathing exercises are essential

• Early mobilization is encouraged

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 Risks and complications

Although generally safe, risks may include:

• Infection

• Bleeding

• Air leak

• Pneumonia

• Rare injury to surrounding structures

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 What are the benefits of decortication?

• Allows full lung expansion

• Improves breathing

• Removes infection source

• Prevents long-term complications

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While thoracoscopic surgery (VATS) is highly effective in many cases, not all patients are suitable for a minimally invasive approach. In advanced stages—particularly stage III empyema, where a thick fibrous peel firmly traps the lung—open surgery (thoracotomy) may be required to achieve complete decortication and allow proper lung expansion. The choice between VATS and open surgery depends on the stage of the disease, the extent of fibrosis, and the patient’s overall condition.

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FAQs About Lung Decortication (Empyema Surgery)

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What is lung decortication?

Lung decortication is a surgical procedure that removes a thick fibrous layer from the lung surface, allowing the lung to expand normally.

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When is lung decortication needed?

It is needed in cases of empyema, trapped lung, or chronic pleural thickening that prevents normal lung expansion.

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Can all cases be treated with VATS?

No. Early and intermediate stages can often be treated with VATS, but advanced cases (stage III empyema) may require open surgery.

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What is the difference between VATS and open decortication?

VATS uses small incisions with faster recovery, while open surgery is used in more advanced or complex cases.

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Is lung decortication a major surgery?

Yes, it is a major procedure, but it is generally safe when performed by an experienced thoracic surgeon.

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How long does the surgery take?

Usually between 2 to 4 hours, depending on the severity of the condition.

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How long is the hospital stay?

Typically 3 to 7 days, depending on recovery and lung expansion.

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What is the recovery time?

Most patients return to normal activities within 2 to 4 weeks after VATS.

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What are the risks of lung decortication?

Possible risks include infection, bleeding, air leak, and pneumonia.

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Will breathing improve after surgery?

Yes, most patients experience significant improvement in breathing after successful decortication.

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When should I see a thoracic surgeon?

If you have persistent chest infection, fluid around the lung, or difficulty breathing.

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 Our experience

Dr. Mohammad Al-Tarshihi has been performing thoracoscopic lung decortication since 2007, with extensive experience in managing complex pleural diseases.

📞 Book your consultation

If you have been diagnosed with empyema or have persistent chest infection, early surgical evaluation is essential.

📱 +962779794141
📍 Amman – Jordan
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