aguillon decor ti cation and exploratory thoratocomy

8/8/2019 Aguillon Decor Ti Cation and Exploratory Thoratocomy

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Decortication is a medical procedureinvolving the surgical removal of thesurface layer, membrane, or fibrous cover ofan organ. The procedure is usuallyperformed when the lung is covered by athick, inelastic pleural peel restricting lungexpansion. his outer lining of the lung iscalled the parietal pleura, and thedecortication process in this case is knownas a pleurectomy



I t is usually a palliative procedure,meaning it simply relieves the symptomsand is not considered a potential cure.

For patients with mesothelioma,typically, the purpose of the procedure isto control fluid that tends to build uparound diseased lungs, which will helpto decrease painful pressure and improvethe patient's ability to breathecomfortably



The decortication process requires generalanesthesia, meaning that the patient isunconscious throughout the procedure.Depending on the condition of the patient,chemotherapy or radiation therapy may beadministered while the cancer is exposedduring surgery. The procedure requires thatthe patient stay in the hospital for several daysafterward for observation and recovery



thoracotomy is a surgical procedure inwhich the chest wall (thorax) is opened,allowing access to the organs beneath it. Alateral thoracotomy provides access to thelungs, major blood vessels, and the esophagus,and an anterior thoracotomy provides access tothe heart and coronary arteries.



Thoracotomy may be needed for lung cancer,other tumors, tuberculosis, lungabscesses, bronchiectasis, emphysema, collapsed lung, gas in the lung (pneumothorax), bloodin the lungs (hemothorax), or injuries that haveresulted in collapsed lung. I t is sometimesperformed in emergency situations in whichtraumatic injuries and episodes have occurredin the chest and near the heart and lungs, suchas a stab or gunshot wound. I t is also oftenused in conjunction with heart surgery and inthe treatment of recurring pneumothorax orhemothorax.



For biopsy of the lung, of the outer covering ofthe lung (pleura), of the site where nerves andvessels enter or leave (hilum), and of thecentral part of the thoracic cavity

(mediastinum), thoracotomy is the diagnosticgold standard to which all other proceduresmust be compared. However, other proceduressuch as thoracoscopy and mediastinoscopy

have decreased the need for thoracotomy



All are done under a general anesthesia.In anterior thoracotomy, a vertical incision is madefrom the base of the neck to the lower end of thebreastbone (sternum). The sternum is divided with asaw (sternotomy) and gently pried apart. With theheart exposed, the necessary surgery can be performed.

In a lateral thoracotomy, an incision is madebetween the ribs to allow access to the lungs.The incision is made from back to front alongthe rib line. The ribs are spread apart, andoccasionally part of a rib is removed. The lungmay be biopsied through the incision.



Following the procedure, a temporarydrainage tube is inserted into the pleural cavity(the space between the membranes lining thechest wall and the membranes covering thelungs). This allows fluid to drain and permitsair in the pleural space to be removed, therebyallowing the lung to fully expand. If theprocedure involved a sternotomy, the sternumis closed with strong stitches or wire. Themuscles and overlying skin are closedwith stitches .



The outcome depends on the type and severityof the problem, but many individuals recoveruneventfully. The hospital stay is usually 7 to10 days. The chest tube remains in place untilthe lung has fully expanded (typically 48 to 72hours). Pain is managed with medications.

may result in death of the individual.



C omplications vary according to the organ orsystem being examined and treated.C omplications may include reactions tomedications, breathing difficulty,bleeding, infections, blood clots, pneumonia,and chronic pain from damage to the nerves inthe chest. Additionally, lung collapse due topoor post-operative re-expansion (atelectasis)or due to a persistent opening between thelung and the chest wall (bronchopleural fistula)can result. There can also be complicationsassociated with receiving general anesthesia.Severe cardiac problems



The principle of nonmaleficence is consideredby some rule-deontological and rule-utilitariantheorists to be the foundation of socialmorality. Some philosophers viewnonmaleficence and beneficence as similar anddistinct obligations of human life. Beneficencesuggests the acts of mercy, kindness, andcharity. I t includes any form of action thatbenefits another



N onmaleficence is distinguished from and part of theprinciple of beneficence by its commitment to notinflict harm to an individual. Beneficence involvespositive acts of preventing harm, removing harm, andpromoting good

The principle of nonmaleficence supports several moralrules. Rules prohibiting harmful actions are at the coreof morality - for example, "Don't kill," "Don't causepain," "Don't deprive of freedom of opportunity," and"Don't deprive of pleasure



The principle of double effect, which is a part ofthe principle of nonmaleficence, provides forthe understanding that good can come out of abad act.

The principle of double effect has been invoked tosupport claims that an act having a harmfuleffect such as death does not always fall undermoral prohibitions such as the rule againstkilling

aguillon decor ti cation and exploratory thoratocomy

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