Information about your surgery for pleurectomy, blebectomy, bullectomy, and talc pleurodesis

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1 Feedback 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: From a mobile or abroad: ext or Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR 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 or phone ext The Trust endeavours to ensure that the information given here is accurate and impartial. 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: ext /57769 Angela Edwards & Debbie Raffle, Thoracic Surgery Department January All rights reserved. Nottingham University Hospitals NHS Trust. Review January Ref: 0394/v3/0115/AM. Public information

2 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) 2 11

3 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. 10 3

4 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. 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. 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. 4 9

5 After your operation 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. 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. Are there any alternatives? 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. 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). 8 5

6 What about my medication? 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. 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. Different types of procedure 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. 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. 6 7

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