Simultaneous pancreas and kidney transplantation is major surgery, involving quite big laparotomy and dissection. Generally, large laparotomy and major open surgery is considered to be relative (even absolute) contraindication to laparoscopy.
On the other side, laparoscopic surgery is associated with less incidence of postoperative complication compare to open approach. This benefit is even more significant in transplant patient. These patients, due to extensive co-morbidity and immunocompromised status are known to have higher incidence of postoperative complications.
Therefore, there is dilemma if in the case of need to remove gallbladder or any other elective surgery, laparoscopic option should be considered.
Dear Elijah,
We need to move away from the mind set that patients having had transplants are different. If the preferred treatment option for any disease entity is a laparoscopy directed therapy, then transplant patients should not be denied that. Kidney pancreas transplant patients have a midline laparatomy often complicated by intraabdominal sepsis and necessary reoperations often with the consequent dense adhesions. Nonetheless a trial laparoscopy is mandated in all. This is our practice whether it is for gall bladder surgery or incisional hernias or anything else.
A trial laparoscopy is by all means not contraindicated in the context. I think that it is only a matter of operator`s knowledge and of patients comorbidity.
Dear Dr. Elijah,
A specific or site specific insicion has been used for the procedures like pankreas and kidney tx. Such incision is often not relevant to the abdomen, abdominal space. In some cases require surgery we have easily performed laparoscopy. that means laparoscopic procedure for one with kidney tx is not unindication like that Mr. Pergialiotis sad. but the team should be experienced.
This is an interesting discussion. Laparoscopic procedures following transplants have been widely described in the literature .
http://www.ncbi.nlm.nih.gov/pubmed/22546137
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