Lithotomy-related complications in the lower limbs after colorectal surgery

Sajid MS, Shakir AJ, Khatri K, Baig MK. Lithotomy-related neurovascular complications in the lower limbs after colorectal surgery. Colorectal Dis. 2011 Nov;13(11):1203-13. Full-text for Emory users.

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.

Beraldo S, Dodds SR. Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position. Dis Colon Rectum. 2006 Nov;49(11):1772-80. Full-text for Emory users.

Lithotomy Position
The simple act of leg elevation in healthy subjects decreases the mean arterial pressure at the toe by 0.8mmHg/cm of elevation. [3] Patients with falsely high ankle brachial pressure index (ABPI), in whom the vessels are calcified, show an even higher drop when placed in the lithotomy position. [22] There also are different forms of lithotomy position (low, standard, high, and exaggerated) that differ from one another by the degree of hip angulation and the height of leg placement above the heart. [23]

It has been hypothesized that the lithotomy position may cause “kinking” of veins at the hip or knee, [9] which could cause an increase in venous pressure and explain the rapid decrease in the CP after the patient returns to the supine position. [24] (Beraldo, et al., 2006, p. 1776)

See also:

Hara K, et al. Prevention of well-leg compartment syndrome following lengthy medical operations in the lithotomy position. Surg Open Sci. 2020 Nov 11;3:16-21.

Gelder C, et al. A systematic review of mechanical thromboprophylaxis in the lithotomy position. Surgeon. 2018 Dec;16(6):365-371.

Frezza EE. The lithotomy versus the supine position for laparoscopic advanced surgeries: a historical review. J Laparoendosc Adv Surg Tech A. 2005 Apr;15(2):140-4.

Canterbury TD, Wheeler WE, Scott-Conner CE. Effects of the lithotomy position on arterial blood flow in the lower extremities. W V Med J. 1992 Mar;88(3):100-1.

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