The pluero-peritoneal communication in the diaphragm provokes hepatic hydrothorax in patients with cirrhosis. Thus the usefulness of thoracoscopic diaphragmatic plication was evaluated in patients with hepatic hydrothorax following identification of the communication through injection of perflubutane in the ascites. Perflubutane solutions at a volume of 0.5 mL were intraperitoneally injected in 17 cirrhotic patients with refractory hepatic hydrothorax from October 2007 to December 2015, and the pluero-peritoneal communication was identified in 11 patients. Among them, thoracoscopic examinations were done in 5 patients and plication procedures were underwent in 4 patients except one patient in whom the communication was not identified thoracoscopically. In this patient, diaphragmatic reinforcing using polyglycolic acid and fibrin paste was done followed by pleurodesis. Consequently, pleural effusions disappeared in 4 patients and decreased in one patient, while peritoneal effusions were increased in 4 patients and transjugular intrahepatic portosystemic shunt procedures were done in 2 patients to improve dyspnea. Thoracoscopic diaphragmatic plication attenuated hepatic hydrothorax due to the pleural-peritoneal communication in safe, and may improve the quality of life in cirrhotic patients.