Head-down tilt lithotomy position and well-leg compartment syndrome: An international survey of current practice

Aim: Well-leg compartment syndrome (WLCS) is a serious complication of prolonged surgery in the head-down tilt lithotomy (HDTL) position associated with increased postoperative morbidity and mortality. However, there is a lack of awareness and clinical guidance regarding prevention of WLCS. The aim of this study was to assess current HDTL-related practices and occurrence of WLCS among a global cohort of clinicians. Method: An international online survey of clinicians was conducted between July and December 2023. Data analysis involved descriptive statistics, machine learning techniques and qualitative content analysis. Results: A total of 595 clinicians from 71 countries and 14 specialities participated. Most (98%) reported routine use of HDTL, 27% of whom did not implement any preventive strategies. ‘Leg rest’ was the most reported preventive measure (41%), commonly initiated after 2 or 3 h of HDTL (79%), for 10–15 min (56%). Overall, 170 cases of WLCS were reported by 21% of respondents. The majority reported unilateral WLCS (81%) following a laparoscopic procedure (63%) performed in HDTL (64%). Only 28% of respondents discussed WLCS during consent for operations in HDTL. Machine learning identified ‘duration of uninterrupted HDTL’ as a positive predictor of the occurrence of WLCS (p < 0.001). Content analysis demonstrated that clinician perspectives and practices regarding WLCS are significantly influenced by personal experience, mostly due to a poor evidence base and lack of standardized institutional policies. Conclusion: Perioperative practices during procedures in HDTL vary substantially, and are primarily informed by clinician experience and preferences. There is a need for evidence-based consensus on best practices to enhance safety during procedures in HDTL. © 2025 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

Авторы
Uzoma Chukwuemeka C. 1, 2 , Shepherd Anthony I. 1 , Saynor Zoe Louise 3 , Khan Jim S. 4, 5 , Piozzi Guglielmo Niccolò Niccolò 4 , Duhoky Rauand 4, 6 , Askew Christopher D. 7 , Ozmen Mahir M. 8, 9 , Middleton Thierry R.F. 1 , Masum Shamsul K. 10 , Perissiou Maria 1 , Goswami Aakansha Giri , Aziz Aamir , Elnour Abdolazeem , Ndong Abdourahmane , Hamid Abdul Fattah Bin , Khan Abdullah , Kulfi Abdullahi Musa , Mylonakis Adam , Adeyeye Ademola A. , Fuentes Adriana Liceaga , Mikneviciute Agne , Hassouneh Ala’ , El-Hussuna Alaa , Aregawi Alazar Berhe , Aiolfi Alberto , Arezzo Alberto A. , Herrando Alberto Ignacio , Vannelli Alberto , Malagnino Alessia , Julianov Alexander E. , Kozadinos Alexandros , Theodorou Alexis , Yildirim Ali Cihat , Guner Ali , Malik Ali , Mohamedahmed Ali Yasen Y. , Bulut Alisina , Antonelli Amedeo , Botros Amir , Mureb Amro Ahmed , Zakaria Andee Dzulkarnaen , Divizia Andrea , Guida Andrea Martina , Romanzi Andrea , Gumbs Andrew A. , Lynch Andrew Craig , Day Andrew , Marra Angelo Alessandro , Parello Angelo , Paspala Anna , Lin Anthony , Castaldi Antonio , Luberto Antonio , Laganà Antonio Simone , Koutras Antonios , Picciariello Arcangelo , Ioannidis Argyrios , Papadopoulos Aristeidis , Rashid Arshad , Kerawala Asad Ali , Marinis A.D. , Pantelis Athanasios G. , Syllaios Athanasios , Acheson Austin George , Saklani Avanish P. , Oladayo Ayandele Babajide , Kobalava Badri , Hemmelová Beata , Drago Beatrice , Yohannes Binyam , Sebastian Boby , Ratto Carlo , Gianmaria Casoni Pattacini , Guldogan Emir , Ciubotaru Cezar Ionut , Onyeze Chigozie Innocent , Agbo Christian , Bali Christina D. , Fleming Christina A. , Kontopoulou Christina I. , Chouliaras Christos , Benlice Çiğdem , Tatar Cihad , Akyol Cihangir , Coco C. , Peirce Colin B. , Nastos Konstantinos , Gallardo Cristián , Hüscher Cristiano Germano Sigismondo , Wright Danette , Wilby Daniel , Brogden Danielle Rebecca Louise , Verdi Daunia , Merlini David Alessio , Watt David , Pertile Davide , Burke Dermot , Markos Despotidis , Sasia Diego
Журнал
Colorectal Disease
Издательство
John Wiley and Sons Inc
Номер выпуска
6
Язык
Английский
Статус
Опубликовано
Ссылка
Внешняя ссылка
DOI
10.1111/CODI.70134
Номер
e70134
Том
27
Год
2025
Организации
  • 1 Clinical Health and Rehabilitation Team, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
  • 2 Department of Surgery, RUDN University, Moscow, Moscow Oblast, Russian Federation
  • 3 School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
  • 4 Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
  • 5 Faculty of Health Sciences, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
  • 6 School of Computing, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
  • 7 VasoActive Research Group, University of the Sunshine Coast, Sippy Downs, QLD, Australia
  • 8 Mahir Ozmen Clinic (MOC), Ankara, Turkey
  • 9 School of Medicine, Sapienza Università di Roma, Rome, RM, Italy
  • 10 School of Mechanical and Electrical Engineering, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
Ключевые слова
compartment syndrome; global survey; Lloyd-Davies; perioperative practices; prevention and management; robotic surgery
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Другие записи

HEAD-DOWN TILT LITHOTOMY POSITION AND WELL-LEG COMPARTMENT SYNDROME: AN INTERNATIONAL SURVEY OF CURRENT PRACTICE

Статья
Uzoma Chukwuemeka C., Shepherd Anthony I., Saynor Zoe Louise, Khan Jim S., Piozzi Guglielmo Niccolò Niccolò, Duhoky Rauand, Askew Christopher D., Ozmen Mahir M., Middleton Thierry R.F., Masum Shamsul K., Perissiou Maria, Goswami Aakansha Giri, Aziz Aamir, Elnour Abdolazeem, Ndong Abdourahmane, Hamid Abdul Fattah Bin, Khan Abdullah, Kulfi Abdullahi Musa, Mylonakis Adam, Adeyeye Ademola A. ...
Colorectal Disease. Том 27. 2025.