Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis

Abstract

Hydrothorax complicating CAPD is more commonly right-sided, and tends to occur within the first year of starting peritoneal dialysis. Isotope scan and CTP are insensitive in diagnosing pleuroperitoneal communication. A low pleural fluid protein content is the most consistent biochemical finding. VATS talc pleurodesis is a safe and reliable treatment of choice that allows sustained continuation of CAPD with low recurrence rate.

Simple surgical treatment for pleuroperitoneal communication without interruption of continuous ambulatory peritoneal dialysis

“…6 Although hydrothorax most commonly occurs shortly following CAPD induction, hydrothorax can develop anytime during CAPD. 7 It is important to suspect the presence of pleuroperitoneal communication in patients with a hydrothorax arising as a complication of CAPD. If the glucose level in the pleural effusion is higher than the blood glucose level, pleuroperitoneal communication should be strongly suspected.…”

“…The fi rst method is an injection of dialysis solution containing a dye such as indigo carmine, indocyanine green, or methylene blue into the abdominal cavity through the CAPD catheter. 1,7 This method has several advantages: (1) Dye-containing dialysis solution can be injected at any institution because no special techniques or devices are required; and (2) careful thoracoscopic examination of the colored solution can identify the exact breakthrough points intraoperatively. However, attention must be paid to the concentration of dye because too much dilution may lighten the color to such a degree as to create diffi culties in identifying the breakthrough point(s).…”

“…Conservative treatments include natural healing by cessation of the CAPD and pleurodesis with autologous blood, talc powder, or tetracycline, among others. 1,7 However, conservative treatments have unpredictable outcomes and overall are effective in about 50% of cases. 1 Furthermore, these methods also have the disadvantages of prolonging the treatment period and a highly probable transition to hemodialysis.…”

Hidrotórax masivo en un caso de síndrome urémico hemolítico: tratamiento conservador sin interrupción de la diálisis peritoneal

“…1,3,4,11,12 Se supone que una presión abdominal elevada podría ser un factor patogénico relevante, por lo que se han propuesto medidas dialíticas para disminuirla: iniciar la DP con volúmenes bajos, aumento progresivo, acortamiento del tiempo de permanencia, diálisis cíclica con día seco, posición sentada. 1,3,[5][6][7][8][9][10] El hidrotórax pediátrico es de baja prevalencia en dializados crónicos y la mayoría de los casos descritos en la literatura corresponde a pacientes con SUH en DP aguda.…”

Video-assisted thoracoscopic surgery for hydrothorax in peritoneal dialysis patients — check-air-leakage method

“…VATS with talc pleurodesis is a minimally invasive and effective procedure for treating this patient group [2][3][4]. The tools for diagnosing this condition are as follows: chemical analysis (glucose, protein, lactate dehydrogenase) of pleural fluid; methylene blue discoloration of the dialysate followed by thoracocentesis; imaging modalities which identify transfer of radio-opaque or radioactive media across the diaphragm; and, contrast computed tomographic peritoneography [4][5][6].…”