Best Pleurodesis Surgery in Delhi, India

Pleurodesis is a medical procedure that aims to intentionally scar or inflame the tissue lining the lung and chest wall. This scarring, called adhesion, essentially "sticks" the lung to the chest wall, eliminating the pleural space, a potential space between the two layers of pleura (the lining of the lung and chest cavity). Normally, this space contains a small amount of fluid that helps the lung inflate and deflate smoothly during breathing. However, in some cases, air or excess fluid can build up in this space, causing difficulty breathing and other symptoms. Pleurodesis helps prevent this buildup from happening again.

Pleurodesis is performed for two main reasons:

• To Prevent Recurrent Pleural Effusion: This is a condition where excess fluid builds up in the pleural space. This fluid buildup can be caused by various underlying conditions such as congestive heart failure, pneumonia, liver cirrhosis, or even cancer. If the effusion keeps coming back after being drained (a condition called recurrent pleural effusion), a pleurodesis can be a treatment option to prevent future recurrence.
• To Treat Pneumothorax: Pneumothorax is a collapsed lung caused by air leaking into the pleural space. A pleurodesis can help seal the leak and prevent the lung from collapsing again.

Preparing for Pleurodesis

Before undergoing a pleurodesis, the doctor will discuss the procedure in detail with the patient and obtain informed consent. Here's what the patient can expect during the preparation phase:

• Medical history review: The doctor will review the patient's medical history, including any underlying conditions and medications they are taking.
• Physical examination: A physical examination will be performed to assess the patient's overall health and suitability for the procedure.
• Imaging tests: Chest X-ray or CT scan may be ordered to visualise the pleural effusion or pneumothorax and plan the procedure.
• Blood tests: Blood tests may be done to check the patient's blood clotting function and overall health.
• Discontinuation of certain medications: The patient may be asked to stop taking certain medications, such as blood thinners, a few days before the procedure.
• Fasting instructions: The patient will likely be instructed to not eat or drink anything for several hours before the procedure.
• Arranging transportation: The patient should plan for someone to drive them home after the procedure as they may be groggy from anaesthesia.

During Pleurodesis

There are two main types of pleurodesis: chemical and surgical. The type of procedure chosen will depend on the patient's specific situation and the doctor's recommendation.

• Chemical pleurodesis: This is the most common type. A substance, such as talc or doxycycline, is instilled into the pleural space through a chest tube inserted between the patient's ribs. The substance irritates the pleura, causing inflammation and scarring that eventually obliterates the pleural space.
• Surgical pleurodesis: This is a more invasive procedure performed through a thoracoscope (a small camera inserted into the chest) or open surgery. During the procedure, the surgeon may abrade (scrape) the pleural surfaces to promote scarring or introduce a sclerosing agent (scarring agent) similar to those used in chemical pleurodesis.

Both procedures are typically performed under general anaesthesia, meaning the patient will be asleep and pain-free during the surgery. The length of the procedure can vary depending on the complexity but usually takes 30 minutes to 2 hours.

Post Pleurodesis Care

After the procedure, the patient will be monitored in a recovery room for a few hours before being transferred to a hospital room. Here's what the patient can expect during post-operative care:

• Pain management: The patient may experience pain or discomfort after the procedure. Pain medication will be provided to manage this.
• Chest tube: A chest tube may be left in place for a few days to drain any remaining fluid or air from the pleural space. The patient will be instructed on how to care for the chest tube and drainage system.
• Breathing exercises: The patient will be encouraged to perform deep breathing exercises and coughing to help clear their lungs and prevent infection.
• Monitoring: The patient's vital signs, such as heart rate, oxygen level, and respiratory rate, will be monitored closely.
• Diet: The patient may be given a clear liquid diet initially, then gradually progress to a regular diet as tolerated.
• Activity level: The patient will be encouraged to gradually increase their activity level as they recover.
• Hospital stay: The typical hospital stay after pleurodesis is 1-3 days.
• Follow-up appointment: A follow-up appointment will be scheduled with the doctor to monitor the patient's progress and check for any complications.

• Prevention of Recurrent Pleural Effusions: Pleurodesis is highly effective in preventing the re-accumulation of pleural fluid in patients with conditions like malignant pleural effusion, which is common in cancers such as lung and breast cancer.
• Reduction of Pneumothorax Recurrence: For patients with spontaneous pneumothorax (collapsed lung), pleurodesis can significantly reduce the risk of recurrence, providing long-term relief and reducing the need for repeated interventions.
• Symptom Relief: By eliminating the space where fluid or air accumulates, pleurodesis can alleviate symptoms such as shortness of breath, chest pain, and discomfort, improving the patient’s quality of life.
• Minimally Invasive: The procedure can often be performed using minimally invasive techniques, such as thoracoscopy, which typically results in shorter hospital stays and faster recovery times compared to more invasive surgical options.
• Outpatient Procedure Option: In some cases, pleurodesis can be performed as an outpatient procedure, particularly when using chemical agents through a chest tube, allowing patients to avoid lengthy hospital stays.

• Pain and Discomfort: The procedure can cause significant pain and discomfort, especially immediately after the procedure. Pain management strategies are usually necessary.
• Infection: There is a risk of infection at the site where the chest tube is inserted or within the pleural space, which may require additional treatment with antibiotics or further surgical intervention.
• Respiratory Complications: Potential complications include respiratory failure, re-expansion pulmonary edema, or acute respiratory distress syndrome (ARDS), particularly in patients with compromised lung function.
• Failure of the Procedure: In some cases, pleurodesis may not be successful, leading to a recurrence of pleural effusion or pneumothorax, necessitating additional interventions.
• Inflammation and Fever: Patients may experience inflammatory responses, including fever and an inflammatory reaction within the pleural space, which can contribute to overall discomfort and recovery challenges.
• Chemical Pleurodesis Risks: When chemical agents are used for pleurodesis (e.g., talc, doxycycline, or bleomycin), there is a risk of adverse reactions to these agents, including systemic inflammatory response, acute respiratory distress, or other allergic reactions.
• Cardiovascular Risks: In rare cases, pleurodesis can lead to cardiovascular complications, including arrhythmias or myocardial infarction, particularly in patients with pre existing heart conditions.

Considering the benefits and risks, pleurodesis is generally considered for patients with recurrent pleural effusions or pneumothorax when other less invasive treatments are ineffective or not feasible. The decision to proceed with pleurodesis involves careful consideration of the patient’s overall health, underlying conditions, and the potential impact on their quality of life.

Is pleurodesis permanent?

Yes, pleurodesis is intended to be a permanent procedure. It works by causing an inflammatory reaction that fuses the pleural layers together, preventing the reaccumulation of fluid or air in the pleural space.

Can pleurodesis be reversed?

No, pleurodesis cannot be reversed. Once the pleural layers are fused, the process is permanent and irreversible.

How long does pleurodesis surgery take?

The duration of pleurodesis surgery varies, but it typically takes about 1 to 2 hours. The exact time can depend on the method used and the patient's specific circumstances.

What is the recovery time after pleurodesis surgery?

Recovery time after pleurodesis can vary. Most patients can expect to stay in the hospital for a few days to monitor for complications. Full recovery can take several weeks, during which patients may experience pain and discomfort.

What should I expect after pleurodesis surgery?

After pleurodesis, patients may experience chest pain, discomfort, and shortness of breath initially. These symptoms typically improve over time. Patients will likely need pain management and may have a chest tube in place for a few days to drain any remaining fluid.

Is pleurodesis performed under general anaesthesia?

Pleurodesis can be performed under general anaesthesia, especially if done surgically (thoracoscopic pleurodesis). However, chemical pleurodesis can also be performed under local anaesthesia with sedation.

What are the risks associated with pleurodesis?

Risks of pleurodesis include pain, infection, respiratory complications, failure of the procedure, inflammation and fever, and potential adverse reactions to the chemical agents used.

Will I need a chest tube after pleurodesis?

Yes, a chest tube is typically placed after pleurodesis to drain any remaining fluid and ensure the pleural layers stick together properly. The chest tube usually remains in place for a few days.

Can pleurodesis be performed on both lungs?

Yes, pleurodesis can be performed on both lungs if necessary, though it is usually done one side at a time to manage risks and complications.

Can pleurodesis be done as an outpatient procedure?

In some cases, pleurodesis can be performed as an outpatient procedure, particularly when using chemical agents through a chest tube. However, this depends on the patient's overall health and the specifics of their condition.

Will pleurodesis affect my breathing?

Pleurodesis may cause some initial discomfort and shortness of breath, but it is not expected to have a long-term negative impact on breathing. The goal is to improve breathing by preventing fluid or air buildup.

Is there a risk of infection with pleurodesis?

Yes, there is a risk of infection with pleurodesis, especially at the site where the chest tube is inserted or within the pleural space. Proper care and monitoring are necessary to mitigate this risk.

Can pleurodesis be repeated if it fails initially?

Yes, pleurodesis can be repeated if the initial procedure fails to achieve the desired outcome. The decision to repeat the procedure depends on the patient's condition and the reasons for the initial failure.

Reviewed By Dr Ashish Jain- Director and Head Respiratory Medicine Pulmonology on 08 Aug 2024.