Pleurodesis is a procedure aimed to obliterate the intrapleural space and is performed for recurrent malignant/non-malignant effusions and recurrent pneumothorax.
The procedure is performed in two traditional manners – mechanical and chemical. In mechanical pleurodesis, surgeons will usually perform a video-assisted thoracoscopic surgery (VATS), identify the parietal pleura, and rub an abrasive material against the parietal pleura. In chemical pleurodesis, agents like talc, minocycline, doxycycline, and silver nitrate are introduced into the intrapleural space to generate an inflammatory response through chemical irritation of the pleural lining.
In the illustration above, the red zone indicates an area where pleurodesis is being performed. The procedure will ultimately encompass the entire lung to achieve complete apposition between the visceral and parietal pleural layers. Using the aforementioned chemical or mechanical sclerosis techniques, a diffuse inflammatory response is created promoting fibrin adhesions and the proliferation of fibroblasts to basically lock this potential space for pneumothorax, hydrothorax, etc.
Pain management can also be an issue, so we routinely offer multimodal techniques including injection of the pleural lining with local anesthetic, neuraxial blocks, regional nerve blocks, oral pre-medication before the surgery, etc.