Décortication : techniques, indications, résultats ?

Decortication is the technique to remove pleural empyema, whatever their origins. Pleural empyema are made of exudative fluid and often occur in a context of infection (pleural effusion, tuberculosis), trauma (hemothorax), or chylothorax (accumulation of lymphatic fluid). First decortication techniques hâve been described long ago by Hippocrate. Today, there are many différent techniques, more or less invasive, ranging from simple drainage with fibrinolysis to pleurostomy. The reference technique of decortication remains thoracotomy, although videothoracoscopy becomes ever more important and appropriate larger indications. Indications for each technique have to be discussed between pulmonologists, intensivists and surgeons, for each patient. The indication will depend on lengthand cause of the empyema, patient status, and technical available support.