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Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
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Video-assisted thoracic surgery for pleuroperitoneal communication
Shota Mitsuboshi1, Hideyuki Maeda2, Masato Kanzaki1
1Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Surgical Case Reports
|February 21, 2019
Summary
Pleuroperitoneal communication (PPC) causing hydrothorax during continuous ambulatory peritoneal dialysis (CAPD) can be effectively treated with video-assisted thoracic surgery (VATS). Reinforcing the repair with a latissimus dorsi muscle flap prevents recurrence.
Area of Science:
- Nephrology
- Thoracic Surgery
- Medical Imaging
Background:
- Pleuroperitoneal communication (PPC) is a rare complication of continuous ambulatory peritoneal dialysis (CAPD).
- Hydrothorax can necessitate conversion to hemodialysis in approximately 50% of CAPD patients.
- Early diagnosis and effective management are crucial for patient outcomes.
Purpose of the Study:
- To report a case of hydrothorax secondary to PPC in a CAPD patient.
- To evaluate the efficacy of video-assisted thoracic surgery (VATS) in treating PPC.
- To assess the utility of a latissimus dorsi muscle flap in preventing PPC recurrence.
Main Methods:
- A 65-year-old male on CAPD for chronic renal failure presented with hydrothorax.
- Diagnosis of PPC was confirmed using radioscintigraphy with 99mTc-macro-aggregated albumin.
- Surgical repair was performed using VATS with direct suturing and reinforcement with a pedicled latissimus dorsi muscle flap.
Main Results:
- VATS successfully identified and closed the pleuroperitoneal communication.
- The patient resumed CAPD 7 weeks post-surgery.
- No recurrence of hydrothorax was observed post-procedure.
Conclusions:
- Video-assisted thoracic surgery (VATS) is an effective treatment for hydrothorax caused by pleuroperitoneal communication.
- A pedicled latissimus dorsi muscle flap provides robust reinforcement, preventing recurrence of PPC.
- This surgical approach allows for the successful continuation of CAPD.
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