ArticleColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2025
Head-down tilt lithotomy position and well-leg compartment syndrome: An international survey of current practice.
Article in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Efficacy of controlling external pressure on the lower leg during surgical positioning on preventing rhabdomyolysis and well leg compartment syndrome after robot-assisted radical prostatectomy.International urology and nephrology · 2026Article
- Head-down tilt lithotomy position and well-leg compartment syndrome: An international survey of current practice.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2025Article
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12 authors.
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Abstract
aimWell-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.
methodAn international online survey of clinicians was conducted between July and December 2023. Data analysis involved descriptive statistics, machine learning techniques and qualitative content analysis.
resultsA 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.
conclusionPerioperative 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.
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