*Purpose: The purpose of this study was to review the outcomes of abdominal gynecologic (gyne) procedures in patients who have previously undergone pancreas transplantation (PTx).

*Methods: PTx were performed with systemic venous and proximal jejunum enteric exocrine drainage. The head was oriented upward with the tail positioned towards the pelvis. SPK transplants were placed ipsilaterally. All PTx recipients in our transplant database were cross-referenced for any subsequent gyne procedure. Obstetric and extra-abdominal gyne procedures were excluded. Medical histories, operative notes, and hospital courses were reviewed to identify any complications. We also documented whether the presence or assistance of transplant faculty was requested.

*Results: Out of 720 PTx recipients in the database, 17 underwent a total of 19 procedures (2 required two separate gyne procedures). Data is summarized in the table. Mean age was 42.1y (range 32-61y). There were 3 SPK, 3 PAK and 11 PTA. There were 15 laparoscopic procedures and 4 open. All open gyne procedures (i.e., non-laparoscopic) coincided with a separate procedure being performed by the transplant team including retransplantation x2, allograft pancreatectomy or incisional hernia repair. One laparoscopic case coincided with a laparoscopic hernia repair. Procedures are summarized in the table. A transplant surgeon was present for 12 and scrubbed for 7 of those. In all but one case the originally intended procedure was successfully completed with the exception of a cyst and hydrosalpinx that were drained rather than removed because of adhesions involving the transplant organs. Mean and median length of stay were 4.68 and 2 days with a range of 1-30 days. No complications directly involving the pancreas allografts related to the gyne procedures were identified. One patient developed a pelvic hematoma. 5 patients required readmission for c.diff, fever, neutropenia and elevated creatinine, pain and elevated creatinine respectively. One developed an incisional hernia at a laparoscopic port site.

*Conclusions: Although prior PTx can alter the abdominal anatomy and lead to reluctance for future operations, gyne procedures can be performed safely and can be approached primarily laparoscopically. Requesting the presence of a transplant surgeon should be made if the gyne surgeon is unfamiliar with performing procedures on transplant recipients, or if there is concern for extensive adhesions with allograft involvement.

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