Laparoscopic Surgery in Recipients of Intra-abdominal Solid Organ Transplants: A Systematic Review.

Abstract

Objectives: Laparoscopy is a minimally invasive surgical approach that can reduce morbidity compared with open surgery in appropriately selected patients. However, patients with a history of intra-abdominal solid organ transplantation may have postoperative adhesions and altered anatomy, leading to more complex and variable anatomy. It remains unclear whether prior transplantation increases the risk of complications during laparoscopy. This study aimed to evaluate the incidence of complications in patients undergoing laparoscopy following intra-abdominal solid organ transplantation.

Materials and methods: A systematic search of PubMed, EMBASE, and Google Scholar was conducted through October 2023 to identify studies on laparoscopy in postintra-abdominal solid organ transplant recipients. Two independent reviewers identified 30 relevant articles, of which 19 (including case reports, case-control, and cohort studies) met the inclusion criteria. Risk of bias was assessed using the Newcastle-Ottawa scale by two independent reviewers. The study protocol was registered with PROSPERO (CRD42023477254).

Results: Four studies included direct comparisons between transplant and nontransplant patients. The mean postoperative length of stay was 3.5 days among 1402 transplant patients, compared with 2.3 days among 2,640,340 nontransplant patients. Two studies reported a lower rate of wound infection in nontransplant patients compared with posttransplant patients (1.7% vs. 4.8%). Rates of other infections, seroma formation, ileus, and disease recurrence were comparable between groups, although each was reported by only one small study. Two of the four studies were assessed as having a low risk of bias.

Conclusion: Direct comparisons between patients with and without a history of intra-abdominal solid organ transplantation suggest that laparoscopy is generally safe, with a modest increase in hospital stay and wound infection risk in posttransplant patients.