Pleurodesis is a medical procedure that permanently eliminates the space between the lung and the chest wall, preventing the reaccumulation of air or fluid. This space, called the pleural cavity, is lined by the visceral pleura (covering the lung) and the parietal pleura (lining the chest wall). Normally, a small amount of fluid exists between these layers, allowing the lungs to glide smoothly during respiration. Pleurodesis deliberately causes these two pleural layers to stick together, a process known as symphysis. This fusion is achieved by inducing a controlled inflammatory reaction, which leads to the formation of scar tissue or adhesions.
Conditions Requiring Pleurodesis
Pleurodesis is necessary when a patient experiences recurrent accumulation of air or fluid in the pleural space. The two main conditions requiring this procedure are recurrent pneumothorax and recurrent pleural effusion. A pneumothorax, commonly referred to as a collapsed lung, occurs when air leaks into the pleural space, causing pressure that prevents the lung from fully expanding. Since simply draining the air is often insufficient for patients who suffer repeated collapses, a permanent solution is needed to hold the lung against the chest wall.
Recurrent pleural effusion is the excessive buildup of fluid in the pleural space. This condition is often associated with advanced malignancies, such as metastatic lung or breast cancer, causing symptomatic shortness of breath. While repeated drainage, or thoracentesis, offers temporary relief, it does not solve the underlying issue of fluid production. Pleurodesis provides a palliative, long-term solution by sealing the space where the fluid collects, helping to alleviate breathing difficulties.
Methods of Performing Pleurodesis
The procedure is divided into two categories: chemical and mechanical. Both methods aim to create the irritation necessary to fuse the pleural layers.
Chemical Pleurodesis
Chemical pleurodesis involves introducing a sclerosing agent into the pleural space, usually through a chest tube used to drain air or fluid. The most widely used agent globally is sterile talc, administered either as a slurry mixed with saline or as a powder (poudrage). Talc is highly effective, with reported success rates often between 80% and 95%. Other agents, such as the antibiotic doxycycline or the chemotherapy drug bleomycin, are used if talc is unavailable or contraindicated. These substances irritate the pleura’s lining, triggering an inflammatory response that forms fibrous adhesions. Following instillation, the chest tube is often clamped briefly to allow the agent to circulate before drainage resumes.
Mechanical Pleurodesis
Mechanical or surgical pleurodesis is often performed using Video-Assisted Thoracoscopic Surgery (VATS). This minimally invasive technique physically irritates the chest wall lining to generate the required inflammatory response. The surgeon may use an abrasive pad to “scratch” or abrade the parietal pleura, known as mechanical abrasion. Sometimes, a partial parietal pleurectomy is performed, which involves stripping away the parietal pleura entirely. Surgical methods are preferred for treating recurrent pneumothorax because they allow for simultaneous correction of the underlying cause, such as resecting air-filled sacs called blebs.
Recovery and Post-Procedure Expectations
Recovery begins immediately, typically requiring a hospital stay of two to seven days, depending on the method used and the patient’s underlying health. The chest tube remains until the lung is fully expanded and fluid drainage drops to an acceptable level, often below 100 to 150 milliliters over 24 hours. Pain management is important, as the necessary inflammatory reaction often causes substantial chest pain.
Patients receive pain control, which may include local anesthetics administered into the pleural space, systemic opioids, or nerve blocks. Non-steroidal anti-inflammatory drugs (NSAIDs) are usually avoided during the initial post-operative period because they can interfere with the inflammatory process required for the pleural layers to adhere. After discharge, patients should avoid strenuous activity and refrain from lifting objects heavier than ten pounds for several weeks. Pleurodesis is a durable and effective treatment for preventing the future accumulation of fluid or air in the pleural space.