Risk Factors and Outcomes of Bowel Complications in Single-Site Donor Nephrectomy: A Retrospective Analysis of 350 Consecutive Cases.

OBJECTIVES

This study evaluated the incidence, risk factors, and management of bowel complications in a consecutive series of laparoendoscopic single -site donor nephrectomy procedures.

MATERIALS AND

METHODS

A retrospective analysis was performed on 350 consecutive laparoendoscopic single -site donor nephrectomy cases (68 % male donors ; mean age 31.5 ± 8.2 years; mean body mass index 26.1 ± 4.8 ; 8.6 % with prior abdominal surgery ) seen from September 2017 through July 2025 at a high -volume center.

RESULTS

The bowel complication rate was 1.14 % (4 of 350 ). Etiologies included internal herniation (n = 1 ), adhesive obstruction (n = 1 ), obstruction postserosal repair (n = 1 ), and bowel perforation (n = 1 ). All cases required surgical management, including 3 bowel resections and 1 laparoscopic defect closure. The 4 affected donors had a higher mean age (40.1 ±3.9 years ) and mean body mass index (33.7 ± 1.9 ), and 50 % had received prior abdominal surgery, both of which significantly exceeded the cohort baseline. No complications stemmed from initial port insertion or thermal injury. The overall 30 -day readmission rate was 2.28 %, and the recipient 1 -year graft survival rate was 97.3 %.

CONCLUSIONS

Bowel complications following laparoendoscopic single -site donor nephrectomy are rare but clinically significant, predominantly presenting postoperatively and requiring surgical intervention. High body mass index and a history of abdominal surgery are key associated risk factors. Meticulous surgical technique remains paramount to minimize risk. Therefore, meticulous surgical technique and careful patient selection, particularly in donors with obesity or prior abdominal surgery, are more critical to bowel safety than the choice of a minimally invasive approach.