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We appreciate and encourage feedback. If you need advice or
are concerned about any aspect of your care or treatment
please speak to a member of staff or contact the Patient Advice
and Liaison Service (PALS):
Freephone: 0800 183 0204
From a mobile or abroad: 0115 924 9924 ext. 65412 or 62301
E-mail: [email protected]
Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614,
Nottingham NG7 1BR
www.nuh.nhs.uk
Information about your
surgery for pleurectomy,
blebectomy, bullectomy,
and talc pleurodesis
Information for patients
Thoracic Surgery Unit
If you require a full list of references for this leaflet please email
[email protected] or phone 0115 924 9924
ext. 67184.
The Trust endeavours to ensure that the information given here
is accurate and impartial.
Angela Edwards & Debbie Raffle, Thoracic Surgery Department © January 2015. All
rights reserved. Nottingham University Hospitals NHS Trust. Review January 2017. Ref:
0394/v3/0115/AM.
This document can be provided in different languages and
formats. For more information please contact:
Thoracic Surgery Assessment Unit
City Hospital
Hucknall Road, Nottingham
NG5 1PB
Tel: 0115 969 1169 ext. 59667/57769
Public information
Introduction
This leaflet describes the surgical treatment required if you
suffer from recurrent collapse of the lung (pneumothorax) or a
build up of fluid in the chest (pleural effusion).
How is the procedure performed?
This is an operation which allows the surgeon to stick the lung to
the chest wall (pleurodesis). The aims of the procedure are to:


Find the source of leakage of air and to staple this off to
prevent further problems.
Cause the lung to stick to the chest wall so there is no space
for future collection of air, or fluid in the case of pleural
effusion.
The operation can be performed by one of two techniques:
Pain: This can be a painful operation. We will give you strong
pain killers and you will need to continue taking pain killing
medication after discharge for some weeks or possibly months.
Pain tends to wear off and resolve in most people but this can
take up to six months. In a few patients the pain does not get
better and we then refer them to a pain specialist.
Recurrence: There is a small risk of the original problem
recurring.
Going home from hospital
Please talk to your nurse about the timing of your discharge as
letters, appointments and medication have to be arranged
before making your transport arrangements. An outpatient
appointment will be made for you.
If you have any questions, please ask the nursing staff looking
after you.
Video assisted thoracoscopic surgery (key hole)
The operation is performed through a few small incisions in the
side of the chest. This allows the surgeon to pass a small
telescope and instruments into the chest to both perform the
operation and view the inside of the chest on a television
screen. (See illustration on next page)
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Complications and risks
Although we do everything we can to make your operation safe,
lung surgery is major surgery and has some significant risk
factors.
Anaesthesia: A general anaesthetic holds a certain risk for
anyone. You can discuss your individual risk with your
anaesthetist.
Bleeding: This can happen rarely during or after an
operation and may require a blood transfusion or occasionally a
further operation is needed.
Chest infection: This may require a longer course of antibiotics
and/or other medical treatment.
Prolonged air leak: This occurs when the stitch line at the cut
edge of the lung has not healed yet and a small hole is left
which results in an air leak from the lung into the chest. This will
mean your chest drain has to remain in place for a longer time
and your hospital stay may be extended. The risk is about five
per cent.
Blood clots: These can develop in the legs (DVT) and can
move in the bloodstream to the lungs (PE) and cause breathing
difficulties or sometimes death. While you are in hospital we will
give you daily injections into the stomach of blood thinning
drugs to try to prevent any clots and you will be wearing some
elasticated stockings. We also encourage you to mobilise (move
around) immediately after your operation.
Thoracotomy (open operation)
An incision is made in the side of the chest through which the
surgeon performs the operation.
Sometimes the operation may be planned as a keyhole
procedure but the surgeon may find it necessary to carry out an
open procedure if there are any difficulties. The surgeon will
have discussed this possibility with you and will have obtained
your consent for both procedures to be carried out.
Wound infection: These do occasionally occur.
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Why do I need a pleurodesis?
There are a number of different reasons why someone may
require this operation:

Your lung has spontaneously collapsed to different degrees
on two or more occasions and the doctors are concerned
that this will continue to happen. It is important to secure one
lung to avoid collapse of both lungs at the same time.

Your lung has collapsed as a result of an accident or injury
and the doctors feel this is the only course of action to solve
the problem.

You have a pleural effusion (fluid in the space between the
lungs and the chest wall). Draining the fluid and performing a
pleurodesis should stop this happening again.
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In the majority of cases you will be ready to go home three to
eight days after surgery.
While you are in hospital you will be cared for by a variety of
staff including doctors, nurses and the physiotherapists who will
assist you with your coughing, breathing and mobilisation. The
thoracic surgery nurse specialist team will also visit you during
your stay in hospital.
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After your operation
Are there any alternatives?
When you leave recovery you will be taken to either the Barclay
Thoracic Progressive Care Unit (BTPC) or the ward. This is
planned and it is important that your relatives/friends are aware
that this is normal.
Aspiration with a syringe or drainage with a tube (chest drain)
are possible alternatives. However, these will usually have been
performed already before your referral to the surgeon.
The BTPC nurses will be constantly monitoring you and giving
you oxygen via a facemask. You will also be aware of being
connected to a number of drips and drains which will be in place
for a few days:
Intravenous infusion (drip): As you may not be allowed to eat
or drink for a few hours you will have a line inserted into a vein.
We will use this line to give you fluids and drugs, and for
monitoring.
Chest drain: This is a special drain inserted into the chest to
drain any air, fluid or blood that may have collected due to your
operation. This drain will be connected to a portable bottle or
bag.
Urine catheter: A tube is passed via the urethra into the
bladder, which drains constantly into a collection bag.
Paravertebral or epidural line: After the operation you will
have some discomfort in your wound(s). We aim to control your
pain by using a tiny plastic tube that sits in your back. Through
this line we can give you a constant infusion of pain controlling
drugs and local anaesthetics.
After one night most patients are ready to move back to a ward
bed. Here your care and recovery will continue and you will be
assisted and encouraged to get up and about, cough and deep
breathe.
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What will happen if I choose not to have this
procedure?
The decision on whether to have this treatment or not is yours.
However, research has shown that if you do not have the
treatment, you are likely to experience the same problems in the
future.
How do I prepare for the procedure?
You will need an injection the night before. This will be arranged
at your GP surgery if possible or you may attend Barclay
Thoracic Ward or the Elective Admission Lounge (EAL).
You will be admitted to EAL on the morning of your operation.
This will allow you to meet some of our staff and them to meet
you. It will also enable us to prepare you for theatre in a safe
and timely manner. Your stomach must be empty before
surgery, so do not have anything to eat for at least six hours
before your operation.
You may drink water up to two hours before your operation
(three hours if you are diabetic). Your nurse will tell you the
appropriate timing as this will depend on when you are
scheduled to go to theatre.
You will be given some anti-emboli socks to try to prevent blood
clots - deep vein thrombosis (DVT)/pulmonary embolism (PE).
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What about my medication?
Different types of procedure
Specific advice will be given to patients taking Warfarin or
diabetic medication. Otherwise take your usual medication as
normal. Once you are admitted to the ward, your nurse will give
you any medication you require as prescribed by your doctor.
Pleurectomy: This is where the lining of the chest wall is
stripped, making it sticky and allowing the lung to stick to the
chest wall.
What does the procedure involve?
You will be taken on a trolley to theatre. You will be introduced
to the nurses in theatre reception who will then check that you
have a full understanding of your procedure and that you are
willing to go ahead. Any dentures and/or glasses will be
removed and stored for safe-keeping.
You will be taken through to the anaesthetic room where you will
meet the anaesthetist (the doctor who sends you to sleep) who
will put a needle into your hand and give you some drugs to
gently send you to sleep.
When you are asleep you will be wheeled into theatre where the
surgeon will perform the operation.
Abrasion pleurodesis: This is where the pleura (the lining of
the chest wall) is grazed and the resulting inflammatory reaction
causes the lung and the chest wall to stick together.
Blebectomy and bullectomy: Sometimes the cause of a
collapsed lung is little air sacs (pockets) called blebs on the
surface of the lung. When these burst the air they contain
squeezes between the lung and chest wall causing the lung to
collapse. Larger air pockets are called bullae and these can
have the same effect.
These blebs or bullae are removed or stapled, which removes
the cause of your collapsed lung. This should stop the lung on
that side collapsing again.
Once the surgeon has removed these air sacs they are sent to
the pathology laboratory for examination.
Talc pleurodesis: This is a procedure which involves sterile
talcum powder being puffed onto the surface of the lung. This
causes an inflammatory reaction which in turn causes the lung
to stick to the chest wall.
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