pleurectomy
Meaning of pleurectomy: Stripping out a lining so the lung sticks to the chest wall, which is the aim: a space that can no longer refill.
Definition of pleurectomy
A pleurectomy is an operation that strips away the pleura, the thin lining between the lung and the chest wall. Usually the outer layer covering the chest wall is taken, leaving raw surfaces that scar together so the lung stays stuck to the wall. It is used for a lung that keeps collapsing, for fluid that keeps returning, and for some tumors of the lining itself.
What exactly is removed?
The pleura is not one sheet but two continuous layers folded back on themselves. The outer layer coats the inside of the chest wall, the diaphragm and the central partition of the chest. The inner layer wraps the surface of the lung and dips into its fissures. Between them lies a film of fluid a few drops thick, so the lung slides freely while staying pulled outward against the wall. That slim gap is a potential space rather than a real one, and it becomes a real one only when air or fluid forces the layers apart. A pleurectomy usually removes the outer layer, and the operation is named for stripping it out.
Why does removing a lining help?
Because it abolishes the space. Raw chest wall left in contact with the lung surface heals by sticking to it, and once the two are fused there is nowhere for air or fluid to gather. That is the entire purpose in a lung that repeatedly collapses and in a chest that keeps refilling with fluid. Sensation explains a further quirk: the outer layer carries pain fibers while the layer on the lung carries none, which is why lung tissue can be cut without sensation yet inflammation of the lining produces sharp pain on breathing in.
How does it compare with the alternatives?
| Procedure | What is done | The lung |
|---|---|---|
| Pleurectomy | The lining is stripped from the chest wall | Kept |
| Pleurodesis | Talc or a drug provokes the surfaces to stick | Kept |
| Pleurectomy with decortication | The lining is stripped and a rind peeled off the lung | Kept |
| Extrapleural pneumonectomy | Lining, lung and part of the diaphragm removed | Removed |
The last two are the choices in mesothelioma, a cancer arising from the lining itself, and the lung-sparing operation has become the more usual of them. Bleeding from the raw surface is the main early risk, and once the space is obliterated any later operation on that side of the chest is considerably harder.
Also known as
Used in a sentence
A pleurectomy was performed after a third episode of spontaneous pneumothorax.
Good to know
The pleura is a double layer, one sheet lining the chest wall and another covering the lung, and only the layer on the chest wall carries pain fibers, which is why the lung itself is insensitive while inflammation of the lining hurts sharply.
Word origin
Where “pleurectomy” comes from
From the Greek pleura, meaning the side or rib, and ektome, meaning a cutting out.