Surgical Repair of Pleuroperitoneal Communication with Continuous Ambulatory Peritoneal Dialysis

Abstract

Background Pleuroperitoneal communication is a serious complication in patients receiving continuous ambulatory peritoneal dialysis. However, few single-institutional reports discuss the details of pleuroperitoneal communication in continuous ambulatory peritoneal dialysis patients regarding the intraoperative findings, postoperative course, and outcomes. Methods We retrospectively reviewed the records of consecutive pleuroperitoneal communication patients who were treated surgically from September 2008 to March 2016. Results All four patients had right-sided hydrothorax. The time from introduction of continuous ambulatory peritoneal dialysis to the diagnosis of hydrothorax ranged from 1 to 12 months (average: 5.5 months). Case 1 and case 4 had bleblike lesions near the center of the diaphragm; case 2 had a small hole located near the cardiophrenic angle, and case 3 had thinning of the diaphragm near the cardiophrenic angle. All lesions except for case 3 were directly closed with absorbable suture and reinforced by fibrin glue and a polyglycolic acid sheet. In case 3, the thinned diaphragm was reinforced using fibrin glue, a sealing sheet, and pericardial fat pad tissue. Continuous ambulatory peritoneal dialysis was reinitiated an average period of 11 days (range: 4–15 days) postoperatively. During postoperative follow-up, there was no recurrence of hydrothorax. Continuous ambulatory peritoneal dialysis was continued for an average of 16.7 months (range: 3–34 months) after surgical treatment. Conclusions Surgical treatment for pleuroperitoneal communication is a safe and acceptable procedure and could greatly benefit continuous ambulatory peritoneal dialysis patients.

Laparoscopic approach for surgical treatment of pleuroperitoneal communication interfering with peritoneal dialysis: a case report

“…Generally, it is thought that the transfer of peritoneal dialysis fluid through the fistula of the diaphragm to the thoracic cavity causes various symptoms and complicates continued peritoneal dialysis, although pleural effusion can also be caused by lymphatic migration from the abdominal cavity [5]. Therefore, it is considered that proof of diaphragmatic fistulas with a pigment, contrast medium, or isotope is important in the diagnosis, while closure of the fistulas is essential for the treatment of pleuroperitoneal communication [6,7].…”

Video-assisted thoracic surgery for pleuroperitoneal communication

“…In previous reports, PGA sheets, fibrin glue, and pericardial fat pad tissues are used to reinforce the diaphragm for treating PPC [8, 9]. However, the recurrence of PPC is still reported.…”

Surgical management of pleuro-peritoneal fistula in chronic renal failure patient—safety and effectiveness

“…The rationale behind this suggestion is due to the mechanism of pleurodesis in inducing aseptic inflammation and thus approximation of the pleura through fibrosis, a process which requires time to mature. However, other series such as that published by Kumagai et al and Shoji et al suggest that CAPD can be restarted at an earlier date after surgery (3,12). The exact safety period for CAPD suspension is yet to be determined and should be addressed by future studies.…”

“…Diagnosis of CAPD associated PPF can be made clinically with compatible pleural fluid biochemistry, CT peritoneogram or by peritoneal fistulogram (2). Videoassisted thoracoscopic surgery (VATS) has been shown to be an effective and safe means of treating patients with PPF (3).…”