Pleuroperitoneal communications can lead to hydrothorax in patients with ascites or who are undergoing peritoneal dialysis. The lower relative pressure causes preferential migration of fluid into the chest. This can be especially problematic when complicating peritoneal dialysis as it may necessitate conversion to hemodialysis. Diagnosis of pleuroperitoneal communication can be made via peritoneal scintigraphy, with visualization of tracer migration to the chest. The attached video demonstrates an adaptation of reported techniques for pleuroperitoneal communication closure using laparoscopy and thoracoscopy. Once access is gained one might see bubbling of pneumoperitoneum into the chest, however visualization can be improved by spraying dye from the abdomen onto the diaphragm and visualizing leakage into the chest. In this case indocyanine green was used, though methylene blue is also acceptable. The defect was expectedly in the central tendon of the diaphragm, and was closed with 0-Surgidac in a figure of eight. The closure was reinforced with fibrin glue, and a talc pleurodesis was performed, though other types of mechanical and chemical pleurodesis are also described. Immediately post operatively, continuous positive airway pressure was used to encourage lung expansion, this was continued for the first night. The abdominal drain remained in place for 48 hours and the chest tube remained for 4 days. The video shows the most recent postoperative chest x-ray, demonstrating no recurrence of the hydrothorax.