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

Abstract

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

Update Kontraindikationen Peritonealdialyse

“…Leckagen können unter Pausierung der PD verschwinden, eine fortbestehende Leckage ist je doch eine Kontraindikation für die Fortführung der PD. Eine pleuroperitoneale Leckage kann mittels videoassis tierter Thorakoskopie mit Implantation eines Netzes be seitigt werden [11,12].…”

Complications of Peritoneal Dialysis Part I

“…In a retrospective review of ten patients who had PD hydrothorax with visualized diaphragmatic defects on VATS, thoracoscopic mesh implantation resulted in a cure for all patients with no recurrence with a median follow-up of 1.9 years. 22…”