Laparoscopy in Liver Transplantation: The Future Has Arrived

Abstract

In the last two decades, laparoscopy has revolutionized the field of surgery. Many procedures previously performed with an open access are now routinely carried out with the laparoscopic approach. Several advantages are associated with laparoscopic surgery compared to open procedures: reduced pain due to smaller incisions and hemorrhaging, shorter hospital length of stay, and a lower incidence of wound infections. Liver transplantation (LT) brought a radical change in life expectancy of patients with hepatic end-stage disease. Today, LT represents the standard of care for more than fifty hepatic pathologies, with excellent results in terms of survival. Surely, with laparoscopy and LT being one of the most continuously evolving challenges in medicine, their recent combination has represented an astonishing scientific progress. The intent of the present paper is to underline the current role of diagnostic and therapeutic laparoscopy in patients waiting for LT, in the living donor LT and in LT recipients.

Totally Laparoscopic Distal Gastrectomy in Post Liver Transplant Patient

“…6 In another study, laparoscopic gastrectomy showed fewer inflammatory and immunologic reactions compared to open gastrectomy. 10 In contrast to the increased role of diagnostic and therapeu-tic laparoscopy in liver transplantation, 7 only one case report was published; laparoscopy assisted distal gastrectomy in liver transplantation patient. No more report has been reported since then.…”

“…In contrast to the increased role of diagnostic and therapeutic laparoscopy in liver transplantation, 7 only one case report was published; laparoscopy assisted distal gastrectomy in liver transplantation patient. No more report has been reported since then.…”

“… 6 Likewise, the use of laparoscopy is markedly increasing in the field of liver transplantation. 7 In 2011, the first report was published regarding laparoscopy assisted distal gastrectomy to be a feasible method for gastric cancer treatment in patient with previous liver transplantation. 8 However, there have been no more reports since then.…”

Is single‐port laparoscopy feasible after liver transplant?

“…The role of laparoscopy following solid organ transplant has changed over the years. Initially considered not suitable after transplantation, laparoscopy has acquired acceptance in kidney‐transplanted patients first, given the extraperitoneal nature of the approach and the lower risk of thick intraperitoneal adhesions . Over time, minimally invasive procedures have been increasingly accepted also in liver‐transplanted patients, including laparoscopic lymphocele drainage, laparoscopic adhesiolysis, and laparoscopic repair of incisional hernia .…”

“…For this reason, most surgeons would opt for an open laparotomy in children who underwent liver transplant and need further abdominal surgery. However, recently this view has been challenged by some authors, who do not consider laparoscopy after liver transplantation an absolute contraindication, but actually a possible indication in selected cases .…”