Comparison of Transperitoneal vs. Retroperitoneal Laparoscopic Donor Nephrectomy: Impact on Quality of Life and Complications.

Background Since laparoscopic donor nephrectomy (LDN) has fewer complications and a shorter recovery period than open surgery, it has become the accepted method for living kidney donation. However, the transperitoneal (TP) and retroperitoneal (RP) hand-assisted procedures are frequently employed among LDN techniques.  Objectives At our institution, two distinct techniques for hand-assisted laparoscopic live donor nephrectomy (HALDN) are currently in use: the TP and the RP approaches. This study aims to compare these two surgical approaches across multiple clinically relevant outcomes. The primary endpoints include perioperative complication rates, postoperative pain levels, time to return to normal daily activities, postoperative renal function in donors, and donor-reported perceptions of body image following surgery. Methods A retrospective study of 30 donors who underwent HALDN at Alhada Armed Forces Hospital, Al Hada, Saudi Arabia, from 2024 to 2025 (11 TP and 19 RP), was conducted. Complications, creatinine levels, pain assessment, body image assessment, and quality of life (QoL) were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, NY, USA). Results The perioperative creatinine levels in both groups were similar. The TP group only experienced an initial significant drop in serum creatinine (p = 0.024), while the RP group experienced much larger postoperative reductions in this measure (p < 0.001). Abdominal pain persisted more after surgery for RP donors (p = 0.010). However, there were no discernible variations in complications, QoL, or body image satisfaction. Conclusion Both TP and RP LDN methods have comparable results in terms of overall kidney function, patient satisfaction, and QoL. Although the RP method greatly improves early creatinine results, it is linked to more lasting postoperative pain. As a result, the surgical approach should be chosen individually, taking into account both patient-specific and anatomical factors.