Gastrointestinal Surgery

Abdominal operations can require considerable planning in transplant recipients. Potential allograft injury from operative trauma, or by compromise of its vascular supply must be avoided. Again, when possible enteral immunosup-pression should be maintained. Hepatobiliary operations, pancreatic procedures, and splenectomy do not usually require perioperative change to intravenous immunosuppression. However, gastric resection or repair, and other intestinal procedures usually require a period of intravenous cyclosporine or tacrolimus.

Acute appendicitis can provide a challenging diagnostic dilemma after transplantation. This diagnosis should be prominently considered when evaluating patients with abdominal pain and tenderness. Diverticulitis and/or perforation of the sigmoid colon is also relatively common. Again, immunosuppressed patients may present with relatively advanced disease requiring emergent operation. When colon resection is required, fecal diversion using an end colostomy provides the most conservative, and therefore the most desirable approach. We usually wait at least 6-8 weeks before considering elective stoma closure in this population.

We have previously observed that biliary calculous disease is associated with cyclosporine administration, possibly related etiologically to cyclosporine induced cholestasis.3 Therefore, even after cholecystectomy, de novo biliary stone formation

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