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 Elsevier B.V., All rights reserved.

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 , 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 , Watt David , Pertile Davide , Burke Dermot Anthony , Markos Despotidis , Sasia Diego , Ntourakis Dimitrios , Papaconstantinou Dimitrios C. , Tsapralis Dimitrios , Korkolis D. , Chrysikos Dimosthenis T. , Carrola-Gomes Diogo , Bowley Douglas M.G. , Dardanov Dragomir , Thorgersen Ebbe Billmann , Ozdemir Egemen , Kadhim Ekhlas Jabbar , Spartalis E. , Andriopoluou Eleni , Reitano Elisa E. , Li Elizabeth , Van Eetvelde Ellen , Akpo Emmanuel Esaba , Gönüllü Emre , Günay Emre , Tekin Enver , Harrison Ewen , Yılmaz Eyup Murat , Sammartano Fabrizio , Cheung Fangyi , Huda Farhanul , Di Marco Federica , Aljarad Feras , Carannante Filippo , Mohd Hayati Mohd Firdaus , Poelmann Floris B. , Decebal Fodor , Dixon Frances , Bianco Francesco Maria , Pata Francesco , Murillo Gabriela Arroyo , Marchitelli Gabriella , Van Van Ramshorst Gabrielle H. , Colletti Gaia , Paramasvaran Ganendra , Fragulidis Georgios Panagiotis , Rallis Georgios , Stravodimos Georgios K. , David Gerald , Calini Giacomo , Carganico Giacomo , Formisano Giampaolo , Cassese G. , Pellino Gianluca , Bogani Giorgio , Dalmonte Giorgio , Lisi Giorgio , Cestaro Giovanni , Turri Giulia , Brisinda Giuseppe , Cucinella Giuseppe , Frazzetta Giuseppe , Martin-Martin Gonzalo P. , Gbenga Habeeb Olufemi , Karakullukcu Haluk Kerim , Krentel Harald , Mukhtar Hasan , Elmansi Abdalla Hashim E. , Mangal Hemendra Kumar , Elfeki Hossam Ayman , Daniels I.R. , Darwich Ibrahim A. , Garzali Ibrahım Umar , Egbuchulem Ifeanyichukwu Kelvin , Merlini Ilenia , Ismayilov İlgar , Turan İlknur , Katsaros Ioannis , Virlos Ioannis T. , Negoi I. , Ahmed Irfan , Andreuccetti Jacopo , Glasbey James C. , Olivier James , Wheeler James M.D. , Ahmed Jamil , Cagaš Jan , Torkington Jared J. , Sagar Jayesh , Meyer Jérémy , Teoh Jeremy Yuen Chun , Mah Jin Jiun , Afam-Osemene John , Lee Jonathan , Bulte Joris Paul , Mathew Joseph , Davies Richard Justin , Sahnan Kapil , Malhotra Kashish , Gunasekare Kaushika , Kamer Kemal Erdinç , Rida Khaled , Vasileios Kollaras C. , Apostolou Konstantinos G. , Bouchagier Konstantinos A. , Kopanakis Konstantinos , Stratakis Konstantinos , Mikhail Kosachenko , Jourand Kris J. , Khobragade Krunal Harishchandra , Samarakoon Lasitha Bhagya , Oladimeji Lawal Bashir , Siragusa Leandro , Dimitrios Linardoutsos , Víctor López , Bonomo Luca Domenico , Pio Luca , Taglietti Lucio , Battaglia Luigi , Bonavina Luigi , Khan Mah Muneer , West Malcolm A. , Cannistrà Marco , Catarci Marco , Giacometti Marco , Sighinolfi M.C. , Papadoliopoulou Maria , Sotiropoulou Maria G. , Trompetto Mario , Kryžauskas Marius , Paraoan Marius Taniel , Potter Mark A. , Brincat Mark R. , Spalluto Marta , Rutegård Martin , Podda Mauro Guido , Frountzas Maximos , Koç Mehmet Ali , Özduman Mehmet Ömer , Abdella Mejudin Kedir , Güler Mert , Spartalis Michael D. , Vailas Michail G. , Adamina Michel , Ballabio Michele Maria , Thaha Mohamed A. , Sultan Mohamed A. , Ebrahim Mohamed Ayman , Khan Mohammad Faraz , Inamdar Mohammed Basheeruddin , Eid Mohammed Atef , Thanapal Mohanaraj , Azahar Mohd Syakir , Andrea Morini , Shalaby Mostafa , Johan Syamim , Shafique Muhammad Salman , Shamim Muhammad , Younis Muhammad Umar , Ergenç Muhammer , George Mukoro Duke , Kalin Murat , Uzunoglu Mustafa Yener , Arslan Naciye Çiǧdem , Samalavičius Narimantas Evaldas , Curtis Nathan J. , Kumar Navin , Sang Nguyen Thanh , Wong Nicholas , Cinardi Nicola , De'angelis Nicola , Flamey Nicholas , Tamini Nicolò , Chatzizacharias Nikolaos A. , Koliakos Nikolaos N. , Machairas Nikolaos A. , Michalopoulos Nikolaos V. , Eli Nnaemeka , Kızıltoprak Nurhilal , Okkabaz Nuri , Akinbami Nurudeen , Ekwunife Okechukwu Hyginus , Özkan Ömer Faruk , Yalkın Ömer , Irowa Omorodion Omoruyi , Yalav Orçun , Ioannidis Orestis M. , Milito Pamela , Vassiliu Panteleimon , Delrio Paolo , Herzog Pascal , Tejedor Patricia , Okeny Paul K. , Ihnát Peter I. , Agbonrofo Peter I. , Vlček Petr , Pucher Philip H. , Fransvea P. , Naik Prashant , Thambi Prem Varghese , Wichendu Promise N. , Mckinney Rachel , Grau Rafael G. , Salas Rafael Sanchez , Galleano Raffaele , Izquierdo Raimundo , Peravali Rajeev , Aoun Rany , Aggarwal Ravi , Reid Rebecca , Isaacs Reinaldo , Monteiro Renan Carlo Colombari , Campanati Renato Gomes , Patel Rikesh , Sampietro Roberto , Crolla Rogier M.P.H. , Cabantac Romulo R. , Mbiine Ronald , Azuaga Rubén Dominguez , Oyewale Saburi O. , Sasi Sajith Pankajavihar , Balkan Salih Müjdat , Di Saverio S. , Stefan Samuel S. , Aniello Santoro Giulio , Keong See Boon , Demirli Atici Semra , Subramaniam Sentilnathan , Kim Seon-Hahn , Efetov Sergey , Navarro Sergio M. , Arinkan Sevcan Arzu , Leventoǧlu Sezai , Shaikh Shafaque , Middleton Simon B. , Manfredelli Simone , Basu Somprakas , Christodoulou Spyridon , Dritsas Spyridon , D'ugo Stefano , Bogdan Stoica , Kapiris S. , Karn Summi , Krivan Sylvia , Sztipits Tamas , Çolak Tahsin , Uprak Tevfik Kıvılcım , Petropoulou Thalia , Sidiropoulos Theodoros A. , Ayase Tigabu Daniel , Koëter Tijmen , Dominioni Tommaso , Fontana Tommaso , Violante Tommaso , Gwaram Usman Adamu , Ebochue Uzochi , Calu Valentin , Munikrishnan Venkatesh , Sud Vikas , Vigorita V. , Bellato V. , Bresadola Vittorio , Aliyev Vusal , Dar Wasim , Khan Zafar Ahmed , Şenol Zafer , Jaddoa Zainab Obaid , Nikolaos Zampitis , Yankai Zhang , Garoufalia Zoe , Din Zubair Ud , Zygomalas Apollon N. , Anestiadou Εlissavet , Lakshmi Harish Neelamraju , Nefeli-Kaiti Tomara , Kuzu Mehmet Ayhan , De Nardi P. , Iryivuze Olivier , Dhaygude Sudhir , Paisol Nadzlee Harith Bin , Rauf Sidra , Tsepov Denis , Hasan Mahmudul , Alberts Justin C. , Prasannakumar Akshay Bavikatte , Turu Dorottya , Adam Ahmed , Yeşildal Cumhur , Eltyeb Hazim Abdulnassir , Baeza-Ibáñez Pablo , Azharuddhin Mohd , Amhaimed Ahmad , Velez Claudia Alejandra Antón , Et-Tayab Ouazzani , Speake William James , Kirkan Emre Furkan , Mishra Megha , Paraskevopoulos Ioannis , Picardi Biagio , Méndez Braulio Francisco Reyes , Bako Victor , Deryol Rıza , Ayele Henok Teshome
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, United Kingdom
  • 2 Department of Surgery, RUDN University, Moscow, Russian Federation
  • 3 School of Health Sciences, University of Southampton, Southampton, United Kingdom
  • 4 Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
  • 5 Faculty of Health Sciences, University of Portsmouth, Portsmouth, United Kingdom
  • 6 School of Computing, University of Portsmouth, Portsmouth, United Kingdom
  • 7 VasoActive Research Group, University of the Sunshine Coast, Sippy Downs, Australia
  • 8 Mahir Ozmen Clinic (MOC), Ankara, Turkey
  • 9 School of Medicine, Sapienza Università di Roma, Rome, Italy
  • 10 School of Mechanical and Electrical Engineering, University of Portsmouth, Portsmouth, United Kingdom
Ключевые слова
compartment syndrome; global survey; Lloyd-Davies; perioperative practices; prevention and management; robotic surgery
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АКТУАЛЬНЫЕ ПРОБЛЕМЫ МЕЖДУНАРОДНЫХ ОТНОШЕНИЙ И ВНЕШНЕЙ ПОЛИТИКИ В ХХI ВЕКЕ

Монография
Аватков В.А., Апанович М.Ю., Борзова А.Ю., Бордачев Т.В., Винокуров В.И., Волохов В.И., Воробьев С.В., Гуменский А.В., Иванченко В.С., Каширина Т.В., Матвеев О.В., Окунев И.Ю., Поплетеева Г.А., Сапронова М.А., Свешникова Ю.В., Фененко А.В., Феофанов К.А., Цветов П.Ю., Школярская Т.И., Штоль В.В. ...
Общество с ограниченной ответственностью Издательско-торговая корпорация "Дашков и К". 2018. 411 с.