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Colorectal Disease - 2025 - Uzoma - Head‐down tilt lithotomy position and well‐leg compartment syndrome An international2.79 MB
Published VersionCC BY V4.0, Open Access
Journal article
Head-Down Tilt Lithotomy Position and Well-Leg Compartment Syndrome: An International Survey of Current Practice
Colorectal Disease , Vol.27(6), pp.1-9
2025
Abstract
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.
Details
- Title
- Head-Down Tilt Lithotomy Position and Well-Leg Compartment Syndrome: An International Survey of Current Practice
- Authors
- Chukwuemeka C Uzoma - University of PortsmouthAnthony Ian Shepherd - University of PortsmouthZoe Saynor - University of SouthamptonJim S Khan - Portsmouth Hospitals NHS TrustGuglielmo Niccolò Piozzi - Portsmouth Hospitals NHS TrustRauand Duhoky - Portsmouth Hospitals NHS TrustChristopher Askew - University of the Sunshine Coast, Queensland, School of Health - Sports & Exercise ScienceM Mahir Ozmen - Sapienza University of RomeThierry R F Middleton - University of PortsmouthShamsul Masum - University of PortsmouthMaria-Christina Perissiou (Corresponding Author) - University of PortsmouthHDTL-WLCS Global Survey Collaborating Group (Research Group)
- Additional notes
- Presented in abstract form to the European Society of Coloproctology Conference, Thessaloniki, Greece, 25–27 September 2024; published in the Conference Abstracts Book ePosters: Colorectal Disease 2024;26(S2):31–388 PO298 (https://doi.org/10.1111/codi.17125).
- Publication details
- Colorectal Disease , Vol.27(6), pp.1-9
- Publisher
- Wiley-Blackwell Publishing Ltd.
- Date published
- 2025
- DOI
- 10.1111/codi.70134
- ISSN
- 1463-1318; 1462-8910
- Copyright note
- © 2025 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Data Availability
- The dataset utilised in the preparation of this manuscript is available on the Open Science Framework (10.17605/OSF.IO/YR7KD).
- Grant note
- This project was funded by the Faculty of Science and Health, University of Portsmouth.
- Organisation Unit
- Healthy Ageing Research Cluster; Cancer Research Cluster; School of Health - Sports & Exercise Science
- Language
- English
- Record Identifier
- 991115152202621
- Output Type
- Journal article
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