The impact of Toldt fascia dissection on postoperative bowel habits in laparoscopic living donor nephrectomy

INTRODUCTION: For living kidney donation, laparoscopic donor nephrectomy (LDN) is currently the universally accepted approach. Essential steps of the transperitoneal technique include mobilizing the left colon and dissecting Toldt’s fascia to expose the kidney. This study aims to assess how these specific surgical maneuvers influence postoperative bowel recovery and to determine the clinical relevance of requiring laxatives after surgery.
METHODS: We retrospectively reviewed data from 129 donors who underwent left LDN. Based on bowel function recovery and laxative requirements, the cohort was stratified into two groups: The “Early Group” (spontaneous gas/stool on day 1–2, no laxatives; n=90) and the “Late Group” (gas/stool on day 3–4, required laxatives; n=39). Comparison points included demographics (age, gender, BMI), length of stay (LOS), complications, and postoperative creatinine.
RESULTS: The Early Group comprised 69.7% (n=90) of the cohort, while 30.3% (n=39) fell into the Late Group. No significant differences were observed between groups in age (36.4±14.4 vs 41.3±18.5 years; p=0.234), gender distribution (56.7% vs 66.7% female; p=0.385), or BMI (25.60±5.54 vs 26.76±5.55 kg/m²; p=0.275). Likewise, no statistically significant difference was found in LOS (mean 4.14 days vs 4.41 days; p=0.275). Postoperative infection rates, drain usage, and maximum creatinine levels (p=0.881) were also comparable.
DISCUSSION AND CONCLUSION: Performing standard left colon mobilization and Toldt fascia dissection during LDN is safe and does not cause permanent bowel dysfunction. The requirement for postoperative laxatives indicates a temporary functional delay rather than structural injury, confirming the safety of the transperitoneal approach.

Keywords: Nephrectomy, living donors, gastrointestinal motility, ileus, cathartics, postoperative complications

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