Role of Pleurectomy in Managing Pleural Disorders

Introduction

Pleurectomy is a surgical procedure involving partial or complete removal of the pleura—the thin membrane lining the lungs and chest wall. It is commonly performed to control recurrent pleural conditions and improve lung expansion. Appropriate postoperative care and physiotherapy are necessary for optimal respiratory recovery.

procedure

Pleurectomy is a surgical procedure performed under general anesthesia to remove part or all of the pleura lining the chest cavity. After positioning the patient, the surgeon accesses the thoracic cavity through thoracotomy or video-assisted thoracoscopic surgery (VATS). The diseased pleural tissue is carefully separated and excised from the lung surface and chest wall. Bleeding is controlled, and lung expansion is ensured. A chest tube is placed to drain air and fluid, and the incision is closed in layers. Postoperatively, pain control, chest physiotherapy, and monitoring are essential for recovery.

Indications

Pleurectomy is indicated in the following conditions:

• Recurrent spontaneous pneumothorax
• Chronic pleural effusion unresponsive to conservative treatment
• Recurrent pleural infections or empyema
• Malignant pleural diseases
• Persistent air leak from the lung

Contraindications

Pleurectomy may not be suitable in certain cases, including:

• Severe cardiopulmonary instability
• Inability to tolerate general anesthesia
• Poor general health or advanced frailty
• Extensive metastatic disease with limited life expectancy
• Severe coagulation disorders
• Uncontrolled infection or sepsis

Signs and Symptoms

Patients undergoing pleurectomy may experience:

• Chest pain at the surgical site
• Shortness of breath
• Reduced chest expansion
• Fatigue and weakness
• Shallow breathing due to pain
• Cough with or without sputum
• Decreased exercise tolerance

Physiotherapy Management

Physiotherapy plays a crucial role in recovery following pleurectomy:

• Breathing exercises to improve lung expansion
• Incentive spirometry to prevent atelectasis
• Postural drainage and airway clearance techniques, if required
• Chest mobility and thoracic expansion exercises to prevent lung complications 
• Early mobilization to reduce complications
• Upper limb range of motion exercises to prevent shoulder stiffness
• Gradual endurance and functional training
• Patient education on breathing control and posture

Physiotherapy helps restore respiratory function, prevent pulmonary complications, and enhance overall quality of life.

Complications

Possible complications associated with pleurectomy include:

• Postoperative pain and stiffness
• Prolonged air leak
• Bleeding or hemothorax
• Infection 
• Reduced lung compliance
• Respiratory complications such as pneumonia
• Shoulder dysfunction due to thoracic surgery

Conclusion

Pleurectomy is an effective surgical intervention for managing recurrent and chronic pleural disorders. While it can remarkably improve lung function and symptom control, comprehensive postoperative physiotherapy is essential for optimal recovery. A multidisciplinary approach ensures decreased complications, improved respiratory efficiency, and better functional outcomes.