Communication Site Ligation and Polyglycolic Acid Sheet Use for the Treatment of Hydrothorax in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Kubokura, Hirotoshi; Okamoto, Junichi; Usuda, Jitsuo

doi:10.5761/atcs.nm.18-00066

Cited by 11 publications

(5 citation statements)

References 4 publications

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“…1B). There were no complications both intra-and postoperatively, and the patients were discharged after a median stay of 5 days [4][5][6][7][8][9][10][11][12].…”

Section: Resultsmentioning

confidence: 93%

“…During follow-up, none of the surgically treated patients experienced recurrence, in contrast to eight of 14 PD patients treated nonsurgically. In another case series, 4 PD patients with PL were treated with VATS with ligation of the defect and covering the diaphragm using a polyglycolic acid sheet, over which adhesive chemicals were sprayed [ 11 ]. After a follow-up up to 46 months, there were no cases of recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Thoracoscopic mesh implantation as a definitive treatment approach for peritoneal dialysis-associated hydrothorax

Nemeth¹,

Mustafi²,

Friedel³

et al. 2022

Updates Surg

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Pleuroperitoneal leakage with the formation of hydrothorax is a rare complication of peritoneal dialysis, usually necessitating termination of peritoneal dialysis. We hypothesized that implantation of a polypropylene mesh on the diaphragm using video-assisted thoracoscopic surgery might induce permanent closure of pleuroperitoneal leakage. We report a case series of n = 12 peritoneal dialysis patients with pleuroperitoneal leakage and right-sided hydrothorax who underwent video-assisted thoracoscopy with mesh implantation from 2011 to 2020. Pleuroperitoneal leakage had been confirmed before surgery by intraperitoneal administration of toluidine blue, contrast-enhanced computer tomography or glucose determination from the pleural effusion. Median time from the start of peritoneal dialysis to manifestation of pleuroperitoneal leakage was 52 days. Video-assisted thoracoscopic surgery revealed multiple penetration points in the tendinous part of the diaphragm in all patients, which appeared as blebs. These were closed by covering the whole diaphragm with a polypropylene mesh. In all patients, peritoneal dialysis was paused for three months and bridged by hemodialysis. After restarting peritoneal dialysis and a median follow-up time of 1.9 years, none of the patients experienced a recurrence of pleuroperitoneal leakage. This case series demonstrates that pleuroperitoneal leakage in peritoneal dialysis patients can be permanently closed using thoracoscopic mesh implantation and allows peritoneal dialysis to be continued as renal replacement therapy. Graphical abstract

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“…1B). There were no complications both intra-and postoperatively, and the patients were discharged after a median stay of 5 days [4][5][6][7][8][9][10][11][12].…”

Section: Resultsmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Thoracoscopic mesh implantation as a definitive treatment approach for peritoneal dialysis-associated hydrothorax

Nemeth¹,

Mustafi²,

Friedel³

et al. 2022

Updates Surg

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“…There are many varying therapeutic methods like: conservative approach (temporary discontinuation of CAPD, temporary change to hemodialysis, reduction of the CAPD exchange volume, repeated thoracocentesis) [2], pleurodesis (mechanical rub pleurodesis [11] and chemical pleurodesis adopting talc [12], tetracycline [13], brin glue [14], OK-432 [13], autologous blood [15] et al), and surgery [4,5,7] according to reports until now. No matter what kind of therapeutic method was adopted, the required pleural adhesion could not always be rmly formed, leading to the recurrence of hydrothorax [3].…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for pleuroperitoneal communication complicating peritoneal dialysis

et al. 2023

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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. MethodsOur 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. ResultsAfter 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). ConclusionsVideo-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.

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“…Ähnliche vielversprechende Ergebnisse wurden von 2 japanischen Fallserien an 11 bzw. 4 PD-Patienten berichtet, die nach Netzimplantation die PD-Therapie rezidivfrei wieder aufnehmen konnten 9 , 19 . Bei der VATS-gestützten Netzimplantation traten in allen Fallserien postoperativ wie langfristig keine Komplikationen auf, insbesondere wurden keine pulmonalen Probleme berichtet.…”

Section: Ergebnisse Der Vats-gestützten Netzimplantation Bei Pleuroperitonealer Leckageunclassified

Die pleuroperitoneale Leckage

Artunc

2022

Dialyse aktuell

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ZUSAMMENFASSUNGDie pleuroperitoneale Leckage ist eine seltene Komplikation der Peritonealdialyse (PD), die sich durch einen großen, meist rechtsseitigen Hydrothorax manifestiert. Sie tritt infolge von angeborenen Schwachstellen bzw. Defekten im Zwerchfell auf. Die Diagnose wird durch Nachweis eines Übertritts von toluidingefärbtem Dialysat durch Pleurapunktion oder mittels Computertomografie durch den Nachweis kontrastmittelangehobenen Dialysats im Thoraxraum gestellt. Therapieversuche in Form einer PD-Pause oder Pleurodese sind oft nicht wirksam, sodass eine fortbestehende pleuroperitoneale Leckage bisher das Ende der PD darstellte. Als vielversprechend erweist sich ein videoassistierter thorakoskopischer Eingriff, durch welchen die Leckage entweder mittels Naht oder Netzeinbringung erfolgreich behandelt werden kann.

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Communication Site Ligation and Polyglycolic Acid Sheet Use for the Treatment of Hydrothorax in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Cited by 11 publications

References 4 publications

Thoracoscopic mesh implantation as a definitive treatment approach for peritoneal dialysis-associated hydrothorax

Thoracoscopic mesh implantation as a definitive treatment approach for peritoneal dialysis-associated hydrothorax

Minimally invasive surgery for pleuroperitoneal communication complicating peritoneal dialysis

Die pleuroperitoneale Leckage

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