Key words：pleuroperitoneal communication, continuous ambulatory peritoneal dialysis, video-assisted thoracoscopic surgery 〈Abstract〉 A 53-year-old male with end-stage renal failure due to IgA nephritis commenced peritoneal dialysis. Two months after initiation of CAPD, right hydrothorax developed. After the second recurrence under conservative therapy, dialysis therapy was switched from CAPD to hemodialysis. He was admitted to our hospital to undergo video-assisted thoracoscopic surgery(VATS)for pleuroperitoneal communication(PPC)complicating CAPD. VATS was performed but resulted in failure because we could not detect any communication intraoperatively. He resumed CAPD, with recurrence of hydrothorax. Then we investigated the success rate of VATS for PPC in Japan. The success rate was lower than that had been reported previously, and the success rate was much lower in cases in which communication was not detected intraoperatively. The surgical indications for VATS for PPC in CAPD patients should be given sufficient consideration.