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Yukizawa Y, Kamono E, Takagawa S, Hirotomi K, Higashihira S, Choe H, Inaba Y, Kobayashi N. Evaluation of the Postoperative Risk of Deep Tissue Injury to the Lower Extremities Following Surgery in the Lithotomy Position. Cureus 2024; 16:e57413. [PMID: 38694644 PMCID: PMC11062756 DOI: 10.7759/cureus.57413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
Background The aim of this study was to determine the incidence of deep tissue injury (DTI) and potential risk factors after surgery in the lithotomy position. Methods All patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2017 and December 2021 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded. Results During the study period, 5146 patients, 2055 (39.9%) males and 3091 (60.1%) females, with a mean age of 57.3 ± 17.4 years, underwent surgery in the lithotomy position. Seven (0.14%) patients developed DTI on their calf following surgery. All presented with severe pain and swelling, requiring prolonged hospital stay. Multivariate analysis showed that male sex (odds ratio (OR): 11.43; 95% confidence interval (CI): 1.15-113.34, p = 0.037), higher BMI (OR: 1.32; 95% CI: 1.17-1.50, p = 0.0001), and longer operation time (OR: 1.01; 95% CI: 1.004-1.014, p = 0.0002) were independent risk factors for postoperative DTI. Optimal cut-off values for BMI and operation time were 23.5 kg/m2 (sensitivity = 100%; specificity = 64%) and 285 minutes (sensitivity = 100%; specificity = 90%), respectively. Conclusion Factors significantly associated with DTI include male sex, higher BMI, and prolonged operation time.
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Affiliation(s)
- Yohei Yukizawa
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Emi Kamono
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Shu Takagawa
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Kunihito Hirotomi
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Shota Higashihira
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Hyonmin Choe
- Orthopaedic Surgery, Yokohama City University, Yokohama, JPN
| | - Yutaka Inaba
- Orthopaedic Surgery, Yokohama City University, Yokohama, JPN
| | - Naomi Kobayashi
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
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Arakawa K, Sako A. Well-leg compartment syndrome after robot assisted laparoscopic surgery for rectal cancer: A case report. Int J Surg Case Rep 2023; 104:107924. [PMID: 36801764 PMCID: PMC9958421 DOI: 10.1016/j.ijscr.2023.107924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Lower limb compartment syndrome caused by improper positioning during surgery is called well-leg compartment syndrome. Although well-leg compartment syndrome has been reported in urological and gynecological patients, there have been no reports of well-leg compartment syndrome in patients who have undergone robot-assisted surgery for rectal cancer. PRESENTATION OF CASE A 51-year-old man was diagnosed with lower limb compartment syndrome by an orthopedic surgeon due to pain in both of his lower legs immediately following robot-assisted surgery for rectal cancer. Due to this, we started placing the patient in the supine position during these surgeries, and repositioned the patient to the lithotomy position following intestinal tract cleansing after rectal movement in the latter half of the surgery. This avoided the long-term effects of being in the lithotomy position. We compared the operation time and complications before and after the above measures were changed, in 40 cases of robot-assisted anterior rectal resection for rectal cancer performed at our hospital from 2019 to 2022. We found no extension of operation time and no occurrence of lower limb compartment syndrome. DISCUSSION There have been several reports describing the risk reduction of WLCS using intraoperative postural changes. An intraoperative postural change from a natural supine position without pressure which we reported is considered to be a simple preventive method for WLCS. CONCLUSION Changing the patient from the supine position to the lithotomy position during surgery may be a clinically acceptable countermeasure to prevent lower limb compartment syndrome.
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Affiliation(s)
| | - Akihiro Sako
- Department of Surgery, Hitachi General Hospital, Japan.
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3
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Open Sciatic Nerve Decompression for Compartment Syndrome after Prolonged Lithotomy Position: A Case Report. Medicina (B Aires) 2022; 58:medicina58101497. [PMID: 36295657 PMCID: PMC9612347 DOI: 10.3390/medicina58101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Position-related compressive nerve injury is a frequently reported complication of the lithotomy position. In contrast, compartment syndrome-induced neuropathy after lithotomy with prolonged surgery is rare and prone to misdiagnosis. This case describes the successful open decompression of sciatic neuropathy due to compartment syndrome after a prolonged lithotomy position. Case presentation: A 56-year-old male patient complained of an abnormal sensation in the lower leg and difficulty in dorsiflexion and plantarflexion of the left foot and toes after laparoscopic anterior hepatic sectionectomy for 16 h in a lithotomy position. Physical examination revealed severe pain and paresthesia below the distal left thigh. In manual muscle test grading, dorsiflexion and plantarflexion of the left ankle and toes were classified as grade 1. Computed tomography and magnetic resonance imaging showed ischemic changes in the mid-thigh posterior muscles, and the sciatic nerve was severely swollen at the distal thigh, which was compressed by the proximal edge of the well-leg holder. After debridement of the necrotic tissue and decompression of the sciatic nerve, the pain subsided immediately, and the ankle and toe dorsiflexion motor function improved to grade 4. Conclusions: Most case reports of compressive neuropathy associated with the lithotomy position have been related to conservative treatment. However, if a lesion compressing the nerve is confirmed in an imaging study and the correlation with the patient's symptoms is evident, early surgical intervention can be an effective treatment method to minimize neurological deficits.
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4
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Endo Y, Akatsuka J, Kuwahara K, Takasaki S, Takeda H, Yanagi M, Toyama Y, Mikami H, Hamasaki T, Kondo Y. A Case of Well Leg Compartment Syndrome After Robot-assisted Laparoscopic Prostatectomy:With Review. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:145-147. [PMID: 35466137 DOI: 10.2152/jmi.69.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Robot-assisted laparoscopic prostatectomy (RALP) for prostate cancer was introduced in 2000 and rapidly gained popularity. The Da Vinci Surgical System? can ensure improved local control of cancer and fewer perioperative complications. However, RALP is performed in the steep-Trendelenburg position (a combination of lithotomy and head-down tilt position/Lloyd-Davies position) to obtain a good surgical view, and as a result, well leg compartment syndrome (WLCS) can become a serious complication of RALP. Here, we report a case of WLCS after RALP. A 75-year-old man underwent surgery for prostate cancer and immediately complained of pain and numbness after surgery. The pressure of the four leg compartments increased. Ultimately, we diagnosed the patient with WLCS in his right leg, and an emergency fasciotomy was performed. He completely recovered with no permanent disability and was discharged one month after rehabilitation. Although WLCS after RALP is a rare and severe complication, the patient recovered completely with early diagnosis and intervention. Measuring the compartment pressure is useful when the patient is drowsy immediately after recovery from anesthesia. Preventing WLCS requires identifying this condition as a potential complication of RALP and all urologic surgeries performed in the lithotomy position. J. Med. Invest. 69 : 145-147, February, 2022.
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Affiliation(s)
- Yuki Endo
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Kosuke Kuwahara
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Hayato Takeda
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Yuka Toyama
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | | | - Yukihiro Kondo
- Department of Urology, Nippon Medical School, Tokyo, Japan
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5
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Lee BH, Wijetunga DT, Rajasekaran C, Eng Su Min C, Bin Abd Razak HR. Bilateral Well Leg Compartment Syndrome as a Complication of Prolonged Lithotomy Position in Abdominoperineal Resection Surgery. Cureus 2021; 13:e17975. [PMID: 34667662 PMCID: PMC8516595 DOI: 10.7759/cureus.17975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Patients undergoing prolonged surgery in a lithotomy position may develop acute lower limb compartment syndrome in the absence of trauma or pre-existing vascular disease, otherwise known as well-leg compartment syndrome (WLCS). Early recognition and management would prevent the potential, lethal complications associated with this condition. We present a case of a 55-year-old gentleman who developed bilateral WLCS after prolonged abdominoperineal resection of his pelvic liposarcoma.
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Affiliation(s)
- Bing Howe Lee
- Orthopaedic Surgery, Sengkang General Hospital, Singapore, SGP
| | | | | | | | - Hamid Rahmatullah Bin Abd Razak
- Musculoskeletal Sciences, Duke-National University of Singapore (NUS) Medical School, Singapore, SGP.,Orthopaedic Surgery, Sengkang General Hospital, Singapore, SGP
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6
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Vig KS, Adams C, Young JR, Perloff E, O’Connor CM, Czajka CM. Patient Positioning for Proximal Femur Fracture Fixation: a Review of Best Practices. Curr Rev Musculoskelet Med 2021; 14:272-281. [PMID: 34216364 PMCID: PMC8390611 DOI: 10.1007/s12178-021-09710-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Proximal femur fractures are common traumatic injuries treated by orthopedic surgeons. Preparation and positioning for surgical intervention are critical in the proper management of proximal femur fractures. The purpose of this study was to review the current evidence on the various positioning options for patients and to highlight the principles and emerging techniques to help orthopedic surgeons treat this common injury. RECENT FINDINGS Strategic patient positioning is key to the reduction and fixation of proximal femur fractures without complications. The use of intramedullary devices for the fixation of proximal femur fractures has led to an increased use of the modern fracture table. The fracture table should be used when surgeons are facile with its use to avoid significant complications. Recent best available evidence has suggested increased risk of malrotation associated with the use of the fracture table. The use of the radiolucent table offers the most flexibility, but limits surgeons as multiple assistants are needed to maintain reduction during fixation. Positioning for proximal femur fractures is an important technique for general and trauma orthopedic surgeons. Surgeons need to be aware of the various techniques for positioning of proximal femur fractures due to the diversity of injury patterns and patient characteristics. Each positioning technique has it benefits and potential complications that every orthopaedic surgeon should be familiar with while treating these injuries.
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Affiliation(s)
- Khushdeep S. Vig
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Road, Albany, NY USA
| | - Curtis Adams
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Road, Albany, NY USA
| | - Joseph R. Young
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Road, Albany, NY USA
| | - Eric Perloff
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Road, Albany, NY USA
| | - Casey M. O’Connor
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Road, Albany, NY USA
| | - Cory M. Czajka
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Road, Albany, NY USA
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7
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Li C, Du F, Zhou H, Lu H. Photoacoustic imaging in monitoring of compartmental syndrome in rat extremities. APPLIED OPTICS 2021; 60:2912-2918. [PMID: 33798173 DOI: 10.1364/ao.418517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
Muscle ischemia injury is the essence of compartment syndrome (CS). Photoacoustic (PA) imaging can monitor hemoglobin concentration changes in ischemic tissue by determining the state of light-absorbing molecules. This study investigated whether PA imaging can provide accurate CS monitoring. Rats received compression on the lower hind limb for 3 h to induce ischemia injury, followed by PA imaging of desired muscles for 24 h. PA intensities of the injured group were significantly lower than that in the control group. Histology findings correlated well with the PA findings. The results demonstrated that PA imaging could be a noninvasive and timely tool for clinically monitoring CS.
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8
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Crane J, Seebah K, Morrow D, Pal A. Compartment syndrome: a rare complication following laparoscopic colorectal surgery. BMJ Case Rep 2021; 14:14/3/e240217. [PMID: 33653860 PMCID: PMC7929842 DOI: 10.1136/bcr-2020-240217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a 71-year-old man who developed left calf pain after an elective laparoscopic assisted anterior resection. A clinical picture with a raised creatine kinase and negative Doppler ultrasound was suggestive of compartment syndrome. Successful surgical management was performed with two incisional fasciotomies to release all four compartments of the left leg. The patient recovered well postoperatively. The lateral incision was closed primarily while the medial incision required vacuum-assisted closure dressings and healed by secondary intention. Neither wound required skin grafts. The patient recovered well but had an extended hospital stay due to extensive physiotherapy requirements and mild foot drop. This report is intended as a guide for clinicians when considering differentials in calf pain following surgery and to keep in mind the small risk of developing compartment syndrome after pelvic surgery.
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Affiliation(s)
- Jasmine Crane
- General Surgery, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK .,General Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Kevin Seebah
- General Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Darren Morrow
- Vascular Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Atanu Pal
- General Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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9
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Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative. BJS Open 2021; 5:6137382. [PMID: 33609393 PMCID: PMC7893479 DOI: 10.1093/bjsopen/zraa055] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/15/2020] [Indexed: 12/22/2022] Open
Abstract
Background The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses key domains in the perioperative and anaesthetic management. Methods The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent agreement, whereas less than 80 per cent agreement indicated low consensus. Results The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic management in pelvic exenteration, comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management. Consensus recommendations were developed, based on consensus agreement achieved on 34 statements. Conclusion The perioperative and anaesthetic management of patients undergoing pelvic exenteration is best accomplished by a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus statement has addressed key domains within the framework of current perioperative and anaesthetic management among patients undergoing pelvic exenteration, with an international perspective, to guide clinical practice, and has outlined areas for future clinical research.
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10
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Alshakhas M, Alatel A. Well leg compartment syndrome postorthognathic surgery under hypotensive anesthesia and reverse Trendelenburg position: a case report and literature review. Oral Maxillofac Surg 2021; 25:417-420. [PMID: 33389268 DOI: 10.1007/s10006-020-00936-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/20/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Well leg compartment syndrome is a rare postoperative condition that occurs as a result of non-traumatic ischemic insult. It has similar pathophysiology to compartment syndrome; however, no definitive etiology is identified. Several risk factors such as patient position, leg position, young age, and high BMI for the development of this condition are considered. CASE REPORT A 30 years old male smoker and overweight, underwent mandibular and maxillary osteotomies in reverse Trendelenburg position. He developed a WLCS post-operative and treated with fasciotomy. CONCLUSION Increased Awareness of this rare occurrence and predisposition aids in understanding and prompt management. This article provides a rare case that has occurred in reverse Trendelenburg position with less obvious risk factors than typically reported in the literature.
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Affiliation(s)
- Mohammed Alshakhas
- Oral and Maxillofacial Surgery Division, Prince Mohammed Bin Abdulaziz Hospital, Ar Rawabi, 9259 AlWahah St., Riyadh, 14214, Saudi Arabia.
| | - Abdulla Alatel
- Oral and Maxillofacial Surgery Division, Prince Mohammed Bin Abdulaziz Hospital, Ar Rawabi, 9259 AlWahah St., Riyadh, 14214, Saudi Arabia
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11
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Prevention of well-leg compartment syndrome following lengthy medical operations in the lithotomy position. Surg Open Sci 2020; 3:16-21. [PMID: 33305248 PMCID: PMC7709791 DOI: 10.1016/j.sopen.2020.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/26/2020] [Accepted: 10/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Compartment syndrome that occurs after lengthy surgery in the lithotomy position is known as well-leg compartment syndrome. It has serious consequences for patients, including amyotrophic renal failure, limb loss, and sometimes even death. This study aimed to identify effective preventive measures against well-leg compartment syndrome using a retrospective cohort study of 1,951 patients (985 and 966 in the prevention and control groups, respectively). Material and methods The following preventive interventions were analyzed: (1) changing from the lithotomy position to the open-leg position, (2) removing lower leg pressure caused by the lithotomy position, (3) limiting leg elevation based on the height of the right atrium, (4) horizontally repositioning the operating table every 3 hours, and (5) decompressing the contact area of the lower leg in the lithotomy position during operation. Results Eight cases of well-leg compartment syndrome occurred in the control group, whereas no well-leg compartment syndrome occurred in the prevention group. Conclusion These findings suggest that the five interventions assessed can prevent the development of well-leg compartment syndrome.
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12
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Bommert M, Wagner JK, Sehouli J, Burges A, Schmalfeld B, Veldink H, Schrettenbrunner I, Fleisch M, Richter R, Harter P, Pietzner K. Perioperative management of positioning in gynecological cancersurgery: a national NOGGO-AGO intergroup survey. Int J Gynecol Cancer 2020; 30:1589-1594. [PMID: 32817308 DOI: 10.1136/ijgc-2020-001433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The daily clinical routine in the operating room includes patient positioning. The number of perioperative positioning-related complications is growing, along with the legal proceedings concerning this topic, and only a few guidelines exist to provide specific recommendations. The aim of this survey was to assess perioperative positioning and associated adverse events during gynecological cancer surgery in Germany. METHODS A total of 633 gynecological departments of primary, secondary, and maximum healthcare hospitals in Germany were invited to participate in this multiple-choice online questionnaire. The survey was conducted anonymously for a period of six months. The survey was divided into five different sections: descriptive information about the respondent department, pre- and postoperative management, management of positioning in the operating room based on two fictional case examples, and quality management. RESULTS The response rate of our survey was 29.1 % (184/633). Nearly half of the departments (46.7 %) reported to have had one to five patients with positioning-related complications during the prior 12 months, and 29.1 % had experienced a legal dispute due to positioning-related complications. Departments with more than 50 gynecologic-oncological surgeries per year more often reported positioning-related complications (p=0.003). Standard operating procedures exist in almost every department for laparoscopic (97 %) and open surgery (95.1 %), respectively. DISCUSSION The high number of positioning-related complications throughout all departments of different healthcare levels underlines the relevance of this issue and supports the need for a prospective European registry for further analysis. Training and education for all staff members should be routinely implemented to reduce and prevent positioning-related complications.
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Affiliation(s)
- Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung Essen-Huttrop, Essen, Germany.,Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany
| | - Jenny Katharina Wagner
- Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany.,Department of Gynecology, Campus Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jalid Sehouli
- Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany.,Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander Burges
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, University Hospital Munich Department of Gynecology and Obstetrics Grosshadern Campus, Munchen, Germany
| | - Barbara Schmalfeld
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik Veldink
- Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany.,Department of Obstetrics and Gynecology, Stiftung Mathias-Spital Rheine, Rheine, Germany
| | - Irmela Schrettenbrunner
- Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany.,Department of Obstetrics and Gynecology, Sana Kliniken des Landkreises Cham GmbH, Cham, Germany
| | - Markus Fleisch
- Department of Obstetrics and Gynecology, Helios University Medical Center Wuppertal, Wuppertal, Germany
| | - Rolf Richter
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung Essen-Huttrop, Essen, Germany
| | - Klaus Pietzner
- Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany .,Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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13
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Gill M, Fligelstone L, Keating J, Jayne DG, Renton S, Shearman CP, Carlson GL. Avoiding, diagnosing and treating well leg compartment syndrome after pelvic surgery. Br J Surg 2020; 106:1156-1166. [PMID: 31304580 PMCID: PMC6772077 DOI: 10.1002/bjs.11177] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 01/17/2023]
Abstract
Background Patients undergoing prolonged pelvic surgery may develop compartment syndrome of one or both lower limbs in the absence of direct trauma or pre‐existing vascular disease (well leg compartment syndrome). This condition may have devastating consequences for postoperative recovery, including loss of life or limb, and irreversible disability. Methods These guidelines represent the collaboration of a multidisciplinary group of colorectal, vascular and orthopaedic surgeons, acting on behalf of their specialty associations in the UK and Ireland. A systematic analysis of the available peer‐reviewed literature was undertaken to provide an evidence base from which these guidelines were developed. Results These guidelines encompass the risk factors (both patient‐ and procedure‐related), diagnosis and management of the condition. Key recommendations for the adoption of perioperative strategies to facilitate prevention and effective treatment of well leg compartment syndrome are presented. Conclusion All surgeons who carry out abdominopelvic surgical procedures should be aware of well leg compartment syndrome, and instigate policies within their own institution to reduce the risk of this potentially life‐changing complication.
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Affiliation(s)
- M Gill
- Department of Surgery, East Lancashire NHS Trust, Blackburn, UK
| | - L Fligelstone
- Department of Vascular Surgery, Swansea Bay University Health Board, Swansea, UK
| | - J Keating
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - D G Jayne
- Department of Surgery, University of Leeds, Leeds, UK
| | - S Renton
- Department of Surgery, Northwick Park Hospital, Harrow, UK
| | - C P Shearman
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G L Carlson
- Department of Surgery, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
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14
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Well Leg Compartment Syndrome After Prolonged Pelvic Surgery: Launch of United Kingdom and Ireland Multidisciplinary Clinical Guidelines. Dis Colon Rectum 2019; 62:1150-1152. [PMID: 31490822 DOI: 10.1097/dcr.0000000000001463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Bilateral Well Leg Compartment Syndrome Localized in the Anterior and Lateral Compartments following Urologic Surgery in Lithotomy Position. Case Rep Orthop 2018; 2018:2328014. [PMID: 30538877 PMCID: PMC6261077 DOI: 10.1155/2018/2328014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/19/2018] [Accepted: 11/04/2018] [Indexed: 11/23/2022] Open
Abstract
Well leg compartment syndrome (WLCS) is a rare but severe complication after the surgery in lithotomy position. We present a case of bilateral WLCS that occurred after the prolonged urologic surgery in lithotomy position. A 50-year-old man complained of severe bilateral lower leg pain and swelling sixteen hours after the surgery. Physical examination, elevated serum creatine kinase value, contrasting computed tomography, and elevated compartment pressure strongly suggested the development of bilateral WLCS localized in the anterior and lateral compartments. Emergent single-incision fasciotomy was performed four hours after diagnosis. The patient was treated successfully without any neuromuscular dysfunction. An early and accurate diagnosis is important to avoid the delay of treatment and development of neuromuscular dysfunction.
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Waqas A, Arulampalam T, Naqvi S, Khan J. Positional complications of minimal access surgery, laparoscopic/robotic/transanal surgery. Colorectal Dis 2018; 20:449-450. [PMID: 29502333 DOI: 10.1111/codi.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 02/20/2018] [Indexed: 02/08/2023]
Affiliation(s)
- A Waqas
- Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - T Arulampalam
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - S Naqvi
- Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - J Khan
- Queen Alexandra Hospital, Cosham, Portsmouth, UK
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Gelder C, McCallum AL, Macfarlane AJR, Anderson JH. A systematic review of mechanical thromboprophylaxis in the lithotomy position. Surgeon 2018; 16:365-371. [PMID: 29699782 DOI: 10.1016/j.surge.2018.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Venous thrombosis and compartment syndrome are potentially serious complications of prolonged, lithotomy position surgery. It is unclear whether mechanical thromboprophylaxis in this group of patients modifies the risk of compartment syndrome. This qualitative systematic review examines the evidence base to guide clinical practice. METHOD A systematic review was performed guided by Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, to identify studies reporting relationships between lithotomy position, compartment syndrome and mechanical thromboprophylaxis. The aim was to determine if mechanical thromboprophylaxis influenced compartment syndrome risk in the lithotomy position. RESULTS Sixteen studies were identified: eight case reports or case series (12 patients), two completed audit cycles (approximately 2000 patients), four reviews and two volunteer case control studies (33 subjects). There were no randomised studies. Nine studies associated mechanical thromboprophylaxis with compartment syndrome risk but in each case a causative relationship was speculative. In contrast, five papers, including an experimental, cohort study and two observational, population studies recommended intermittent pneumatic compression as prevention against compartment syndrome in lithotomy position. One review and one case report were unable to make a recommendation. CONCLUSIONS The level of evidence addressing the interaction between the lithotomy position, compartment syndrome and mechanical thromboprophylaxis is weak. There is no conclusive evidence that mechanical thromboprophylaxis causes compartment syndrome in the lithotomy position. There is limited evidence to suggest intermittent pneumatic compression may be a safe method of mechanical thromboprophylaxis if accompanied by strict adherence to other measures to reduce the chance of compartment syndrome. However further studies are required.
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Affiliation(s)
- Chloé Gelder
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Audrey L McCallum
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Alan J R Macfarlane
- Department of Anaesthesia, Pain and Critical Care Medicine, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
| | - John H Anderson
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
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Hefler-Frischmuth K, Lafleur J, Brunnmayr-Petkin G, Roithmeier F, Unterrichter V, Hefler L, Tempfer C. Compartment syndrome after gynecologic laparoscopy: systematic review of the literature and establishment of normal values for postoperative serum creatine kinase and myoglobin levels. Arch Gynecol Obstet 2017. [DOI: 10.1007/s00404-017-4440-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Wessells H. Ventral onlay graft bulbar urethroplasty using buccal mucosa. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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von Keudell AG, Weaver MJ, Appleton PT, Bae DS, Dyer GSM, Heng M, Jupiter JB, Vrahas MS. Diagnosis and treatment of acute extremity compartment syndrome. Lancet 2015; 386:1299-1310. [PMID: 26460664 DOI: 10.1016/s0140-6736(15)00277-9] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute compartment syndrome of the extremities is well known, but diagnosis can be challenging. Ineffective treatment can have devastating consequences, such as permanent dysaesthesia, ischaemic contractures, muscle dysfunction, loss of limb, and even loss of life. Despite many studies, there is no consensus about the way in which acute extremity compartment syndromes should be diagnosed. Many surgeons suggest continuous monitoring of intracompartmental pressure for all patients who have high-risk extremity injuries, whereas others suggest aggressive surgical intervention if acute compartment syndrome is even suspected. Although surgical fasciotomy might reduce intracompartmental pressure, this procedure also carries the risk of long-term complications. In this paper in The Lancet Series about emergency surgery we summarise the available data on acute extremity compartment syndrome of the upper and lower extremities in adults and children, discuss the underlying pathophysiology, and propose a clinical guideline based on the available data.
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Affiliation(s)
| | - Michael J Weaver
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul T Appleton
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, USA
| | - Donald S Bae
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - George S M Dyer
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marilyn Heng
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jesse B Jupiter
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark S Vrahas
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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21
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Lower Leg Compartment Syndrome after Appendicectomy. Case Rep Orthop 2015; 2015:585986. [PMID: 25755900 PMCID: PMC4338393 DOI: 10.1155/2015/585986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 01/11/2015] [Accepted: 01/27/2015] [Indexed: 11/17/2022] Open
Abstract
A 10-year-old boy presented with severe left lower leg pain, uncontrolled with increasing analgesia after appendicectomy. A diagnosis of acute compartment syndrome was made after a delayed referral to the orthopaedic service. The patient subsequently underwent an emergency fasciotomy and made a good functional recovery. To the best of our knowledge this is the first reported case of paediatric lower leg compartment syndrome after appendicectomy in the literature. The case report serves to highlight the importance of maintaining a high index of suspicion for compartment syndrome.
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22
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Bauer ECA, Koch N, Erichsen CJ, Juettner T, Rein D, Janni W, Bender HG, Fleisch MC. Survey of compartment syndrome of the lower extremity after gynecological operations. Langenbecks Arch Surg 2014; 399:343-8. [DOI: 10.1007/s00423-014-1172-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/28/2014] [Indexed: 11/28/2022]
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23
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Bauer EC, Koch N, Janni W, Bender HG, Fleisch MC. Compartment syndrome after gynecologic operations: evidence from case reports and reviews. Eur J Obstet Gynecol Reprod Biol 2014; 173:7-12. [DOI: 10.1016/j.ejogrb.2013.10.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 10/10/2013] [Accepted: 10/31/2013] [Indexed: 11/26/2022]
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Abstract
BACKGROUND AND OBJECTIVES Single-port laparoscopic colectomy is described as a new technique in colorectal surgery. The initial case reports show the safety and feasibility, but the learning curve for this technique is unknown. METHODS Between July 2009 and September 2010, 20 consecutive patients with an indication for right hemicolectomy underwent a single-port laparoscopic approach without bias in selection. The only exclusion criterion was a prior midline laparotomy. The patients were followed up for 30 days. Chart review was completed for up to 35 months to assess long-term morbidity and mortality rates. RESULTS The median age was 65 years (range, 59-88 years). Ninety percent of patients were men. The median body mass index was 28 kg/m(2) (range, 20-35 kg/m(2)). Seventy-five percent of patients had significant comorbidities with an American Society of Anesthesiologists class of 3 or 4. The estimated blood loss was 25 mL (range, 25-250 mL). The median number of pathologic lymph nodes for patients diagnosed with adenocarcinoma was 16 (range, 8-23). There was one conversion to hand-assisted laparoscopic (case 6) and one to open colectomy (case 9) because of the inability to achieve safe vessel ligation. The median hospital stay was 4.5 days (range, 3-7 days). The length of stay for the first 10 patients was 5.1 days, and it was 3.9 days for the last 10 patients (P = .045). There were no significant postoperative complications within 30 days. The mean operative time for the first 10 cases was 198 minutes (range, 148-272 minutes), and it was 123 minutes (range, 98-150 minutes) for the subsequent 10 cases (P = .0001). All intraoperative complications (minor bleeding) occurred within the first 10 patients, with no significant bleeding recorded for the last 10 cases. CONCLUSION Single-port laparoscopic right hemicolectomy can be safely performed in patients who are candidates for conventional or hand-assisted right hemicolectomy with very low intraoperative and postoperative complication rates. The 30-day morbidity rate remained low with this technique. The higher technical difficulty compared with conventional laparoscopy is reflected in the longer initial operative times. The learning curve for a surgeon with advanced laparoscopic skills and adequate procedure numbers seems to be short, requiring approximately 10 cases to decrease operative times to baseline. The role and feasibility of broad adaptation for single-incision laparoscopy in colorectal surgery need to be further evaluated in larger case series and trials.
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Affiliation(s)
- Jacob R Hopping
- Department of Surgery, Saint Louis University, St Louis, MO, USA
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Patel S, Lutz JM, Panchagnula U, Bansal S. Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1). J Anaesthesiol Clin Pharmacol 2012; 28:162-71. [PMID: 22557737 PMCID: PMC3339719 DOI: 10.4103/0970-9185.94831] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Colorectal surgery is commonly performed for colorectal cancer and other pathology such as diverticular and inflammatory bowel disease. Despite significant advances, such as laparoscopic techniques and multidisciplinary recovery programs, morbidity and mortality remain high and vary among surgical centers. The use of scoring systems and assessment of functional capacity may help in identifying high-risk patients and predicting complications. An understanding of perioperative factors affecting colon blood flow and oxygenation, suppression of stress response, optimal fluid therapy, and multimodal pain management are essential. These fundamental principles are more important than any specific choice of anesthetic agents. Anesthesiologists can significantly contribute to enhance recovery and improve the quality of perioperative care.
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Affiliation(s)
- Santosh Patel
- Department of Anaesthesia, Consultant Anaesthetist, The Pennine Acute Hospitals NHS Trust, Rochdale, UK
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26
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Lilleby W, Tafjord G, Raabe NK. Implementation of High-Dose-Rate Brachytherapy and Androgen Deprivation in Patients With Prostate Cancer. Int J Radiat Oncol Biol Phys 2012; 83:933-9. [DOI: 10.1016/j.ijrobp.2011.08.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/09/2011] [Accepted: 08/23/2011] [Indexed: 11/26/2022]
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Sajid MS, Shakir AJ, Khatri K, Baig MK. Lithotomy-related neurovascular complications in the lower limbs after colorectal surgery. Colorectal Dis 2011; 13:1203-13. [PMID: 20478008 DOI: 10.1111/j.1463-1318.2010.02314.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To review the literature on lithotomy-related neurovascular complications (LRNVC) of the lower limbs after colorectal surgery. METHOD Electronic databases were searched for relevant articles, including Medline, EMBASE, Pubmed, CENTRAL and CINHL. RESULTS LRNVC after prolonged lithotomy position during colorectal surgery can be classified into vascular, neurological and neurovascular combined. Compartment syndrome (CS) is the most common clinical presentation. Seven case reports and 10 case series on 34 patients (27 men, 6 women) with CS have been reported. Risk factors included the lithotomy position and duration of surgery of more than 4 h. CONCLUSION In colorectal surgery, lower limb LRNCVs, and CS are rare. A high index of clinical suspicion and early decompression may reduce morbidity.
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Affiliation(s)
- M S Sajid
- Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, UK.
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28
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Abstract
AIM In spite of recent advances in technology and technique, laparoscopic colorectal surgery is associated with increased operating times when compared with open surgery. This increases the risk of acute lower limb compartment syndrome. The aim of this review was to gain a better understanding of postoperative lower limb compartment syndrome following laparoscopic colorectal surgery and to suggest strategies to avoid its occurrence. METHOD A MEDLINE search was performed using the keywords 'compartment syndrome', 'laparoscopic surgery' and 'Lloyd-Davies position' between 1970 and 2008. All relevant articles were retrieved and reviewed. RESULTS A total of 54 articles were retrieved. Of the 30 articles in English, five were reviews, six were original articles and 19 were case reports, of which only one was following laparoscopic colorectal surgery. The remaining 24 were non-English articles. Of these, two were reviews and 22 were case reports, of which only one was following laparoscopic colorectal surgery. The incidence of acute compartment syndrome following laparoscopic colorectal surgery is unknown. The following are believed to be risk factors for acute lower limb compartment syndrome: the Lloyd-Davies operating position with exaggerated Trendelenburg tilt, prolonged operative times and improper patient positioning. Simple strategies are suggested to reduce its occurrence. CONCLUSION Simple preventative measures have been identified which may help to reduce the incidence of acute lower limb compartment syndrome. However, if suspected, timely surgical intervention with four-compartment fasciotomy remains the standard of care.
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Affiliation(s)
- M M Rao
- The John Goligher Colorectal Unit, Leeds General Infirmary, Leeds, UK.
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Daly KA, Wolf M, Johnson SA, Badylak SF. A rabbit model of peripheral compartment syndrome with associated rhabdomyolysis and a regenerative medicine approach for treatment. Tissue Eng Part C Methods 2011; 17:631-40. [PMID: 21361746 DOI: 10.1089/ten.tec.2010.0699] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Peripheral compartment syndrome (PCS) has a complex etiology, with limited treatment options and high patient morbidity. Animal models of PCS have been hampered by differences in cross-species anatomy, physiology, and the relative rarity of the naturally occurring syndrome in animals. In the present study, the combination of saline infusion with intermittent crushing of skeletal muscle consistently caused increased intracompartmental pressure, hypocalemia, and hypercreatinine-phophokinasemia, signs diagnostic of PCS. This method was used to evaluate both the standard PCS treatment, specifically a fasciotomy, and a regenerative medicine approach for treatment-consisting of a fasciotomy with local administration of a biologic scaffold material composed of porcine small intestinal submucosa extracellular matrix (SIS-ECM). The use of this SIS-ECM scaffold in conjunction with a fasciotomy was associated with myogenesis and constructive tissue remodeling in the SIS-ECM-treated animals. At 1 and 3 months after treatment innervated muscle tissue was present at the site of injury. No myogenesis was present in the fasciotomy only treated animals. RAM11+ macrophages, which are associated with constructive tissue remodeling, were present within the injury site in the SIS-ECM-treated animals at 1 month. The present study provides a reproducible animal model with which to study PCS, and shows the potential of a regenerative medicine approach to PCS treatment.
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Affiliation(s)
- Kerry A Daly
- Department of Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pennsylvania 15219, USA
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30
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Loerakker S, Oomens CWJ, Manders E, Schakel T, Bader DL, Baaijens FPT, Nicolay K, Strijkers GJ. Ischemia-reperfusion injury in rat skeletal muscle assessed with T2-weighted and dynamic contrast-enhanced MRI. Magn Reson Med 2011; 66:528-37. [PMID: 21360588 DOI: 10.1002/mrm.22801] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/15/2010] [Accepted: 12/10/2010] [Indexed: 11/07/2022]
Abstract
Pressure ulcers are localized areas of soft tissue breakdown due to mechanical loading. Susceptible individuals are subjected to pressure relief strategies to prevent long loading periods. Therefore, ischemia-reperfusion injury may play an important role in the etiology of pressure ulcers. To investigate the inter-relation between postischemic perfusion and changes in skeletal muscle integrity, the hindlimbs of Brown Norway rats were subjected to 4-h ischemia followed by 2-h reperfusion. Dynamic contrast-enhanced MRI was used to examine perfusion, and changes in skeletal muscle integrity were monitored with T2-weighted MRI. The dynamic contrast-enhanced MRI data showed a heterogeneous postischemic profile in the hindlimb, consisting of areas with increased contrast enhancement (14-76% of the hindlimb) and regions with no-reflow (5-77%). For T2, a gradual increase in the complete leg was observed during the 4-h ischemic period (from 34 to 41 msec). During the reperfusion phase, a heterogeneous distribution of T2 was observed. Areas with increased contrast enhancement were associated with a decrease in T2 (to 38 msec) toward preischemic levels, whereas no-reflow areas exhibited a further increase in T2 (to 42 msec). These results show that reperfusion after prolonged ischemia may not be complete, thereby continuing the ischemic condition and aggravating tissue damage.
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Affiliation(s)
- S Loerakker
- Soft Tissue Biomechanics and Engineering, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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31
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Chung JH, Ahn KR, Park JH, Kim CS, Kang KS, Yoo SH, Chung JW, Kim NS, Lee SJ. Lower leg compartment syndrome following prolonged orthopedic surgery in the lithotomy position -A case report-. Korean J Anesthesiol 2011; 59 Suppl:S49-52. [PMID: 21286459 PMCID: PMC3030055 DOI: 10.4097/kjae.2010.59.s.s49] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 04/28/2010] [Accepted: 05/10/2010] [Indexed: 11/22/2022] Open
Abstract
Surgical procedures necessitating the prolonged use of the lithotomy position can be associated with neuromuscular dysfunction. Compartment syndrome of the lower leg is a grave complication which, if unrecognized, can lead to either permanent neuromuscular dysfunction or limb loss. We report a case of compartment syndrome of lower leg that occurred in male patient aged 20 years after 380 minutes arthroscopic surgery in the lithotomy position.
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Affiliation(s)
- Jin Hun Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea
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Ulrich D, Bader AA, Zotter M, Koch H, Pristauz G, Tamussino K. Well-Leg Compartment Syndrome After Surgery for Gynecologic Cancer. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2010.0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniela Ulrich
- Department of Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
| | - Arnim A. Bader
- Department of Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
| | - Maria Zotter
- Department of Anesthesiology and Critical Care, Medical University of Graz, Graz, Austria
| | - Horst Koch
- Department of Plastic Surgery, Medical University of Graz, Graz, Austria
| | - Gunda Pristauz
- Department of Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
| | - Karl Tamussino
- Department of Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
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Lower Extremity Compartment Syndrome Associated With Hypotensive General Anesthesia for Orthognathic Surgery: A Case Report and Review of the Disease. J Oral Maxillofac Surg 2010; 68:1166-70. [DOI: 10.1016/j.joms.2009.07.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 05/17/2009] [Accepted: 07/25/2009] [Indexed: 11/17/2022]
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Dayton P, Wienke J. The extended knee hemilithotomy position for gastrocnemius recession. J Foot Ankle Surg 2010; 49:214-6. [PMID: 20116303 DOI: 10.1053/j.jfas.2009.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Indexed: 02/03/2023]
Abstract
The focus of this communication is to share an alternative positioning method that we have used over the past 3 years for gastrocnemius recession with the patient supine on the operating table. The technique uses a candy-cane leg holding system to situate the patient in the extended knee hemilithotomy position. We have found that this position provides excellent visualization of the surgical site, furnishes the anesthesiologist with optimal access to the patient, negates the need to turn the patient from prone to supine when adjunct procedures are to be undertaken, and allows the involved extremity to remain sterile throughout the operation, without an increase in complications or cost.
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Affiliation(s)
- Paul Dayton
- Trinity Regional Medical Center, Ft. Dodge, IA, USA.
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Sciaudone G, Di Stazio C, Guadagni I, Pellino G, De Rosa M, Selvaggi F. Compartment Syndrome of the Leg after Pelvic Surgery: Can it Always be Avoided? Am Surg 2009. [DOI: 10.1177/000313480907501225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Guido Sciaudone
- Second University of Naples First Division of General Surgery Naples, Italy
| | | | - Ilaria Guadagni
- Second University of Naples First Division of General Surgery Naples, Italy
| | - Gianluca Pellino
- Second University of Naples First Division of General Surgery Naples, Italy
| | - Michele De Rosa
- Second University of Naples First Division of General Surgery Naples, Italy
| | - Francesco Selvaggi
- Second University of Naples First Division of General Surgery Naples, Italy
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36
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Roig-Vila JV, García-Armengol J, Bruna-Esteban M, Redondo-Cano C, Tornero-Ibáñez F, García-Aguado R. Posición operatoria en cirugía colorrectal. La importancia de lo básico. Cir Esp 2009; 86:204-12. [DOI: 10.1016/j.ciresp.2009.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 02/28/2009] [Indexed: 11/27/2022]
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Malik AA, Khan WSA, Chaudhry A, Ihsan M, Cullen NP. Acute compartment syndrome--a life and limb threatening surgical emergency. J Perioper Pract 2009; 19:137-142. [PMID: 19517954 DOI: 10.1177/175045890901900503] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Acute compartment syndrome is a life and limb threatening condition. Clinical assessment is the diagnostic cornerstone of compartment syndrome but pressure monitoring also has a role in equivocal cases, in unconscious or uncooperative patients, and in patients with nerve blocks and other forms of regional and epidural anesthesia. A high degree of suspicion and early decompression of all compartments at risk are important for a satisfactory outcome.
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Affiliation(s)
- A A Malik
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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