Risk Factors Associated With Surgical Morbidities of Laparoscopic Living Liver Donors

Objective:This study analyzed the incidence and risk factors for surgical morbidities of laparoscopic living donors. Background:Although laparoscopic living donor programs have been established safely in leading centers, donor morbidities have not been discussed sufficiently. Methods:Laparoscopic living donors operated on from May 2013 to June 2022 were reviewed. Donor complications were reviewed, and factors related to bile leakage and biliary stricture were analyzed using the multivariable logistic regression method. Results:A total of 636 donors underwent laparoscopic living donor hepatectomy. The open conversion rate was 1.6%, and the 30-day complication rate was 16.8% (n=107). Grade IIIa and IIIb complications occurred in 4.4% (n=28) and 1.9% (n=12) of patients, respectively. The most common complication was bleeding (n=38, 6.0%). Fourteen donors (2.2%) required reoperation. Portal vein stricture, bile leakage, and biliary stricture occurred in 0.6% (n=4), 3.3% (n=21), and 1.6% (n=10) of cases, respectively. The readmission rate and reoperation rate were 5.2% (n=33) and 2.2% (n=14), respectively. Risk factors related to bile leakage were 2 hepatic arteries in the liver graft (OR=13.836, CI=4.092-46.789, P<0.001), division-free margin<5 mm from the main duct (OR=2.624, CI=1.030-6.686, P=0.043), and estimated blood loss during operation (OR=1.002, CI=1.001-1.003, P=0.008), while the Pringle maneuver (OR=0.300, CI=0.110-0.817, P=0.018) was protective against leakage. Regarding biliary stricture, bile leakage was the only significant factor (OR=11.902, CI=2.773-51.083, P=0.001). Conclusions:Laparoscopic living donor surgery showed excellent safety for the majority of donors, and critical complications were resolved with proper management. To minimize bile leakage, cautious surgical manipulation is needed for donors with complex hilar anatomy.