Minimally invasive surgery for pleuroperitoneal communication complicating peritoneal dialysis

Objective: Pleuroperitoneal communication (PPC) is an uncommon but serious complication of continuous ambulatory peritoneal dialysis (CAPD). At present, there are many kinds of treatment options, with different effects. We describe our single-institutional experiences in the minimally invasive surgery of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis in detail. Methods Our study consecutively enrolled twelve pleuroperitoneal communication patients complicating CAPD. All patients underwent direct closure of the defective diaphragm and mechanical rub pleurodesis under video-assisted thoracoscopy. What’s more, pseudomonas aeruginosa injection was infused into the thoracic cavity postoperatively to further promote pleural adhesion, which was the innovation of our study. The follow-up date was not ended until termination of the study. Results After 1.0-8.3 months (mean: 3.6 months) of CAPD, all twelve patients occurred hydrothorax in the right side. And all these patients received surgery 7-179 days (mean: 38.3 days) after onset. The mean operation time was 63.4 min (range, 27–150 min). Bleblike lesions situated on the diaphragm were discovered in all patients and three patients also had obvious hole on the surface of diaphragm. Pseudomonas aeruginosa injection was infused into the thoracic cavity postoperatively, and three cases occurred fever with remission after 2–3 days of symptomatic treatment. The time from surgery to restarting CAPD ranged from 14 to 47 days, with an average of 22.3 days. There was no recurrence of hydrothorax and transformation to hemodialysis during the follow-up period (mean: 9.0 months). Conclusions Video-assisted thoracoscopic direct closure of the defective diaphragm and mechanical rub pleurodesis plus chemical pleurodesis using pseudomonas aeruginosa injection postoperatively is a safe and effective option for the treatment of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis with 100% success rate.