Laparoscopic surgery after orthotopic liver transplantation

Abstract

Laparoscopic surgery is currently a widely accepted approach to several surgical fields because of its advantages in terms of postoperative pain reduction and easy patient recovery. This approach may be useful even in solid-organ transplantation surgery as a diagnostic or treatment procedure in some surgical complications. From July 1991 to December 1998, we performed 142 liver transplantations on 129 patients. During the postoperative period, many complications occurred. Here we report two cases of intestinal occlusion caused by adhesions and three cases of lymphocele, all approached with laparoscopic surgery. In all cases but one, we were able to complete the surgery by laparoscopic means; in one of the two occlusions, the procedure was switched to laparotomy because of a choledochojejunal anastomosis lesion. The three cases of lymphocele must be considered in a particular manner because such cases, to our knowledge, have never been described in the literature. They always presented with a late-onset right pleural effusion and were located in the retrohepatic, retrogastric, and left paracaval areas, close to the esophageal hiatus. In conclusion, we believe a laparoscopic approach is a useful strategy to solve some surgical complications in patients who underwent orthotopic liver transplantation; however, the use of laparoscopic surgery in this field is strictly connected to the surgeon's experience and versatility.

Minimally Invasive Surgery Is Feasible in Patients with Liver and Kidney Transplantation

“…Generally, when laparoscopic procedures are performed in the early post-transplant period, even for diagnostic purposes, the incidence of conversion to open surgery due to complications like bowel injury may be higher [ 13 ]. We performed laparoscopic radical right hemi-colectomy for a patient with occult cecal cancer presenting as acute appendicitis just 6 weeks after living-donor liver transplant.…”

Abdominal emergencies after liver transplantation: Presentation and surgical management

“…Laparotomy is the most appropriate approach in emergency setting as few papers reported laparoscopy as appropriate to manage surgical acute abdomen after LT. Most studies regarding late complications report incisional hernia, intestinal obstruction, or even lymphocele . In late postoperative period, laparoscopy has been shown to be safe, feasible, and associated with a shorter recovery, reduced postoperative pain, and fewer wound complications in various settings.…”

Pure laparoscopic management of early biliary leakage after liver transplantation: Abdominal lavage and T‐tube placement

“…6 If we consider the immunosuppressive regimen of post-LT patients, it is paramount to preserve their immune status and optimize their recovery while trying to address surgical complications in a minimally invasive manner. To date, reports on the laparoscopic management of surgical complications after LT are limited to late complications such as intestinal obstructions and incisional hernias 7,8 or the treatment of biliary peritonitis after T-tube removal. 9 We have recently reported the successful treatment of early post-LT complications, such as bleeding and intestinal obstructions, with a totally laparoscopic approach.…”