Decrotication is a surgical procedure to remove fluid and a thickened rind around lung. It is performed to treat patients with empyema and fibrothorax.


We typically perform this procedure using the video assisted thoracoscopic surgery (VATS) technique called “VATS decortication.” At times, we use the most advanced robotic system called Da Vinci Xi to perform the lobectomy. The name of the procedure is “Robot-assisted thoracoscopic decortication.” We perform the procedure through small incisions in the chest. We remove the fluid in the pleural space and peel the thickened rind off of the lung. A chest tube is placed in the area at the end of surgery to remove any air or fluid.

Overall, the risks of the operation are very low. Surgical risks may include pneumonia, bleeding and a prolonged air leak from the procedure. With any operation, there is a risk of injuring any structure that we operate around including the nerves, pericardium, and diaphragm. Other risks may include infection at the site of surgery. There is always a risk of needing to convert from a small incision to a larger incision to safely complete the operation.

Hospital Stay: 3-5 Days

After the operation, the patient goes to a recovery area called PACU or post-anesthesia care unit. Once the patient recovers from anesthesia, the patient is admitted to the floor. On average, patients are in the hospital for three to five nights. Patients start a regular diet during the night of the surgery along with pre-emptive pain control with around the clock pain medication. Every day, the chest tube will be evaluated to determine if the tube can be safely removed. Once the patient’s chest tube is removed with good pain control, they are ready to continue the recovery at home.

Pain Management

We advise our patients to stay ahead of the pain with pre-emptive pain control. Instead of taking pain medication after having pain, we ask patients to take pain medication in regular intervals. The typical regimen for post-operative pain medication is:

3 days of Aleve (Naprosyn) 1 tab two times a day

5 days of Tylenol (Acetaminophen) 1 g three times a day

7 days of Neurontin (Gabapentin) 300 mg three times a day.

After 7 days, take Tylenol as needed. If this regimen is not adequate to control pain, we ask patients to call our office.


In order to further help with recovery from surgery, we advise patients to walk at least three times a day, work on the incentive spirometer, and sit in a chair for at least 6 hours a day for about a week after the surgery. We advise patients to avoid heavy lifting for 6 weeks. As long as the patient is not on narcotic pain medication, it is safe to drive.