Well Leg Compartment Syndrome After Abdominal Surgery

Christoffersen, Jens; Hove, Lars Dahlgaard; Mikkelsen, Kim Lyngby; Krogsgaard, Michael

doi:10.1007/s00268-016-3706-8

Cited by 20 publications

(27 citation statements)

References 31 publications

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“…When the compartment pressure is ≥30 mmHg, fasciotomy is recommended for treating WLCS . According to Christoffersen et al , the severity of WLCS depends on the time to diagnosis. Irreversible muscle necrosis reportedly occurs within 6–12 h after circulatory insufficiency , so performing emergency fasciotomy once the diagnosis has been established and high intracompartmental pressures has been confirmed is important.…”

Section: Discussionmentioning

confidence: 99%

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Well‐leg compartment syndrome after laparoscopic low anterior resection for lower rectal cancer in the lithotomy position: A case report

Nishino

Okano

Kawada

et al. 2017

Asian J Endoscop Surgery

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A 64-year-old man underwent laparoscopic low anterior resection for lower rectal cancer. Because he was overweight (BMI, 28.1 kg/m ) with rich visceral fat and a narrow pelvic cavity, the operation was technically difficult and the operation time was 686 min. Postoperatively, the patient immediately complained of pain and swelling of the left lower limb. Laboratory examination showed that serum creatinine kinase was markedly increased and urine myoglobin was positive on postoperative day 1. He was diagnosed with well-leg compartment syndrome and was transported to the trauma and critical care center for emergency fasciotomy. After initial treatment, he was transferred to our hospital on postoperative day 7. He completely recovered after 2 months. Although well-leg compartment syndrome is rare, it is necessary to consider it as a potential complication when performing a long colorectal cancer surgery with the patient in the lithotomy position, particularly when laparoscopic surgery is planned.

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Section: Discussionmentioning

confidence: 99%

“…The risk factors for WLCS are reportedly long‐duration surgery, obesity, head‐down tilt position, and use of elastic stockings . Laparoscopic surgery may be an additional risk factor because venous return is disturbed by pneumoperitoneum pressure.…”

Section: Discussionmentioning

confidence: 99%

Well‐leg compartment syndrome after laparoscopic low anterior resection for lower rectal cancer in the lithotomy position: A case report

Nishino

Okano

Kawada

et al. 2017

Asian J Endoscop Surgery

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“…It should be noted that there are, however, several case reports in which WLCS developed within 4 h. Of 125 case reports identified by Christoffersen and colleagues, the median duration of surgery was 7·5 (range 2–12) h. These were a mix of colorectal, gynaecological, obstetric, plastic surgical and urological procedures.…”

Section: Risk Factors and Preventionmentioning

confidence: 99%

“…As the factor common to published case reports (where this is stated) has generally been an operating time exceeding 4 h, it is recommended that care is taken to document the interval during which the legs are elevated above the heart, and to restrict this to a maximum unbroken period of 4 h. Where technical difficulties or operative challenges prevent safe lowering of the patient's legs (for example, because of the need to control pelvic bleeding), the risk to the patient from lowering the legs may exceed the risk of WLCS.…”

Section: Risk Factors and Preventionmentioning

confidence: 99%

“…Intraoperative hypotension should be corrected where possible and intraoperative fluid therapy optimized to avoid both excessive fluid administration, or inadequate tissue perfusion. 6. Any patient who has undergone pelvic surgery in the lithotomy position, whether or not combined with Trendelenberg tilt, who complains of postoperative leg pain should be suspected of having WLCS.…”

Section: All Surgeons Who Undertake Pelvic Procedures On Patientsmentioning

confidence: 99%

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Avoiding, diagnosing and treating well leg compartment syndrome after pelvic surgery

Gill

Fligelstone

Keating

et al. 2019

British Journal of Surgery

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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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Preventing well leg compartment syndrome among patients in the lithotomy position—Operating room nurses' perspectives: A qualitative study

Susanne,

Åsa

2023

Nursing Open

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AimTo describe operating room nurses' experiences of well leg compartment syndrome and how they work perioperative to prevent it during the lithotomy position.DesignThe study had a qualitative design.MethodsFocus group interviews were performed with 10 operating room (OR) nurses. The interviews were semi‐structured and analysed by qualitative content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ).ResultsThe main theme showed that the OR nurses shoulder duty and responsibility, independently and in the team, but they need more structural support and knowledge. The themes showed that they follow routines whenever possible and take responsibility for positioning; however, they have to balance between flexibility and strict routines. Although they also develop and participate in teamwork, they still need further knowledge.ConclusionThe severe complication of well leg compartment syndrome (WLCS) can occur when the patient is in the lithotomy position. Maintaining the same routines and paying attention to the WHO's surgical safety checklist were described as actions that could prevent well leg compartment syndrome.Patient or Public ContributionNo patient or public contribution. We have interviewed nurses but without financial support since the study was performed and supervised within a master programme.

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Well Leg Compartment Syndrome After Abdominal Surgery

Cited by 20 publications

References 31 publications

Well‐leg compartment syndrome after laparoscopic low anterior resection for lower rectal cancer in the lithotomy position: A case report

Well‐leg compartment syndrome after laparoscopic low anterior resection for lower rectal cancer in the lithotomy position: A case report

Avoiding, diagnosing and treating well leg compartment syndrome after pelvic surgery

Preventing well leg compartment syndrome among patients in the lithotomy position—Operating room nurses' perspectives: A qualitative study

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