The pleura is the inner membrane that covers both the inside of the chest wall and the surface of the lungs. Thanks to the pleura, the heart, lungs and chest wall are not bonded to each other and are able to move freely within the chest cavity. Diseases of the pleura requiring surgical treatment include tumours of the pleura and injuries to the lungs or ruptured alveoli, which lead to air accumulating between the lungs and the chest wall (the so-called tyre).
Treatment of pneumothorax
Pneumothorax occurs when a pulmonary alveoli (air sac) ruptures, leading to an accumulation of air between the lung and chest wall. This causes the lung to collapse, limiting its capacity considerably. The air must then be removed, usually through a tube inserted into the chest cavity. Should the loss of air continue, a surgical adhesion of the lung and pleura is necessary. The lung and pleura are inspected thoroscopically, during which the ruptured air sac is often discovered and can be cut away, and the lung resealed. For the adhesion of the chest wall to the lung, the chest wall is slightly roughened and then two drainage tubes ensure that the remaining air is removed from the chest cavity. These drainage tubes remain in for two to four days. They are then removed, the lung is fully re-expanded and partially bonded to the chest wall. The hospital stay for this procedure is usually about a week.
Pleurodesis (adhesion of the lung to the chest wall in malignant pleural tumour combined with effusion)
This disease, where the chest cavity repeatedly fills up with water and causes a corresponding displacement of the lung, usually occurs when the pleura is affected by a malignant tumour. The malignant growth results in fluid leaking into the space between the chest wall and lungs. In order to prevent displacement of the lungs, they must be bonded permanently to the chest wall. The fluid is removed thoracoscopically and the pleura roughened on both the lung and the chest wall sides. Talcum powder is then applied to produce an irritation, allowing the pleura to adhere to the lungs. This prevents the lungs being displaced by fluid again in the future. The patient regains their normal lung capacity and can breathe better again. Aspiration of the liquid is no longer required. The hospital stay for this procedure is usually about a week.
Surgery for tumours of the pleura
Currently, we know of both benign and malignant pleural tumours. Benign pleural tumours are spherical pseudo-fibrous tumours, which, after reaching a certain size, displace the lung. They are not malignant and can be removed through a simple surgical procedure.
The more complex type of pleural tumour is mesothelioma. This kind of tumour is a malignant growth associated with exposure to asbestos, which can affect the pleura. The treatment of this condition usually requires a multimodal approach, whereby a combination of chemotherapy, surgery and radiotherapy is often necessary. The treatment of mesothelioma usually requires the entire lung, including the entire pleura of that side, to be removed. This surgery requires a longer period of time to complete. The hospital stay is usually a little more than 10 days and the entire treatment process, together with chemotherapy and radiotherapy, may last more than six months.