Head‐down tilt lithotomy position and well‐leg compartment syndrome: An international survey of current practice

Chukwuemeka, C.U.; Anthony, I.S.; Zoe, L.S.; Jim, S.K.; Guglielmo Niccolò Piozzi,; Duhoky, R.; Askew, C.; M Mahir Ozmen,; Thierry R, F.M.; Masum, S.; Perissiou, M.; Aakansha Giri Goswami,; Aziz, A.; Elnour, A.; Ndong, A.; Abdul Fattah Bin Abdul Hamid,; Khan, A.; Abdullahi Musa Kulfi,; Mylonakis, A.; Adeyeye, A.; Adriana Liceaga Fuentes,; Miknevičiūtė, A.; Hassouneh, A.; El-Hussuna, A.; Alazar Berhe Aregawi,; Aiolfi, A.; Arezzo, A.; Alberto Ignacio Herrando,; Vannelli, A.; Malagnino, A.; Julianov, A.; Kozadinos, A.; Theodorou, A.; Ali Cihat Yildirim,; Guner, A.; Malik, A.; Ali Yasen Mohamedahmed,; Bulut, A.; Antonelli, A.; Botros, A.; Amro Ahmed Mureb,; Andee Dzulkarnaen Zakaria,; Divizia, A.; Andrea Martina Guida,; Romanzi, A.; Andrew, A.G.; Andrew Craig Lynch,; Day, A.; Angelo Alessandro Marra,; Parello, A.; Paspala, A.; Lin, A.; Castaldi, A.; Luberto, A.; Antonio Simone Laganà,; Koutras, A.; Picciariello, A.; Ioannidis, A.; Papadopoulos, A.; Rashid, A.; Asad Ali Kerawala,; Marinis, A.; Pantelis, A.; Syllaios, A.; Acheson, A.; Saklani, A.; Ayandele Babajide Oladayo,; Kobalava, B.; Hemmelova, B.; Drago, B.; Yohannes, B.; Sebastian, B.; Ratto, C.; Casoni Pattacini Gianmaria,; Cem Emir Guldogan,; Cezar Ionut Ciubotaru,; Chigozie Innocent Onyeze,; Christian Agbo Agbo,; Bali, C.; Fleming, C.; Kontopoulou, C.; Chouliaras, C.; Benlice, C.; Tatar, C.; Akyol, C.; Coco, C.; Peirce, C.; Nastos, C.; Gallardo, C.; Huscher, C.; Wright, D.; Wilby, D.; Brogden, D.; Verdi, D.; Merlini, D.; Watt, D.; Pertile, D.; Burke, D.; Markos, D.; Sasia, D.; Ntourakis, D.; Papaconstantinou, D.; Tsapralis, D.; Dimitris, P.K.; Chrysikos, D.; Diogo Carrola Gomes,; Bowley, D.; Dardanov, D.; Ebbe Billmann Thorgersen,; Ozdemir, E.; Ekhlas Jabber Kadhim,; Spartalis, E.; Andriopoluou, E.; Reitano, E.; Elizabeth, L.; Ellen Van Eetvelde,; Akpo, E.; Gonullu, E.; Gunay, E.; Tekin, E.; Harrison, E.; Eyup Murat Yilmaz,; Sammartano, F.; Fang Yi Cheung,; Huda, F.; Federica Di Marco,; Aljarad, F.; Carannante, F.; Hayati, F.; Floris Boudewijn Poelmann,; Decebal, F.; Dixon, F.; Bianco, F.; Pata, F.; Gabriela Arroyo Murillo,; Marchitelli, G.; Gabrielle, H.V.V.R.; Colletti, G.; Paramasvaran, G.; Fragulidis, G.; Rallis, G.; Stravodimos, G.; David, G.; Calini, G.; Carganico, G.; Formisano, G.; Cassese, G.; Pellino, G.; Bogani, G.; Dalmonte, G.; Lisi, G.; Cestaro, G.; Turri, G.; Brisinda, G.; Cucinella, G.; Frazzetta, G.; Gonzalo, P.M.; Habeeb Olufemi Gbenga,; Haluk Kerim Karakullukcu,; Krentel, H.; Mukhtar, H.; Hashim, E.E.A.; Hemendra Kumar Mangal,; Elfeki, H.; Daniels, I.; Darwich, I.; Ibrahim Umar Garzali,; Ifeanyichukwu Kelvin Egbuchulem,; Merlini, I.; Ismayilov, İ.; Turan, İ.; Katsaros, I.; Virlos, I.; Negoi, I.; Ahmed, I.; Andreuccetti, J.; Glasbey, J.; Olivier, J.; Wheeler, J.; Ahmed, J.; Cagaš, J.; Torkington, J.; Sagar, J.; Meyer, J.; Jeremy Yuen-Chun Teoh,; Jin Jiun Mah,; Afam-Osemene, J.; Lee, J.; Joris, P.B.; Mathew, J.; Davies, J.; Sahnan, K.; Malhotra, K.; Gunasekare, K.; Kemal Erdinç Kamer,; Rida, K.; Kollaras, C.V.; Apostolou, K.; Bouchagier, K.; Kopanakis, K.; Stratakis, K.; Mikhail, K.; Jourand, K.; Khobragade, K.; Lasitha Bhagya Samarakoon,; Lawal Bashir Oladimeji,; Siragusa, L.; Dimitrios, L.; Victor, L.; Luca Domenico Bonomo,; Pio, L.; Taglietti, L.; Battaglia, L.; Bonavina, L.; Mah Muneer Khan,; Malcolm, A.W.; Cannistra, M.; Catarci, M.; Giacometti, M.; Maria Chiara Sighinolfi,; Papadoliopoulou, M.; Sotiropoulou, M.; Trompetto, M.; Kryzauskas, M.; Marius, T.P.; Mark, A.P.; Mark, R.B.; Spalluto, M.; Rutegård, M.; Podda, M.; Frountzas, M.; Mehmet Ali Koç,; Mehmet Ömer Özduman,; Mejudin Kedir Abdella,; Guler, M.; Spartalis, M.; Vailas, M.; Adamina, M.; Ballabio, M.; Mohamed, A.T.; Mohamed Arif Hameed Sultan,; Ebrahim, M.; Mohammad Faraz Khan,; Mohammed Basheeruddin Inamdar,; Eid, M.; Mohana Raj Thanapal,; Mohd Syakir Mohd Azahar,; Andrea, M.; Shalaby, M.; Muhammad Nur Syamim Bin Che Johan,; Muhammad Salman Shafique,; Shamim, M.; Muhammad Umar Younis,; Ergenç, M.; Mukoro Duke George,; Kalin, M.; Mustafa Yener Uzunoglu,; Naciye Cigdem Arslan,; Narimantas Evaldas Samalavicius,; Curtis, N.; Kumar, N.; Nguyen Thanh Sang,; Wong, N.; Cinardi, N.; De'Angelis, N.; Flamey, N.; Tamini, N.; Chatzizacharias, N.; Koliakos, N.; Machairas, N.; Nikolaos, V.M.; Eli, N.; Kızıltoprak, N.; Okkabaz, N.; Akinbami, N.; Okechukwu Hyginus Ekwunife,; Omer Faruk Ozkan,; Yalkin, O.; Irowa, O.; Yalav, O.; Ioannidis, O.; Milito, P.; Vassiliu, P.; Delrio, P.; Herzog, P.; Tejedor, P.; Okeny, P.; Ihnát, P.; Peter Ikponmwosa Agbonrofo,; Vlček, P.; Philip, H.P.; Fransvea, P.; Naik, P.; Thambi, P.; Wichendu, P.; Mckinney, R.; Rafael Garatea Grau,; Rafael Sanchez Salas,; Galleano, R.; Izquierdo, R.; Peravali, R.; Aoun, R.; Aggarwal, R.; Reid, R.; Isaacs, R.; Renan Carlo Colombari Monteiro,; Renato Gomes Campanati,; Patel, R.; Sampietro, R.; Crolla, R.; Romulo, R.C.3.; Mbiine, R.; Rubén Domínguez Azuaga,; Oyewale, S.; Sajith Pankajavihar Sasi,; Salih Müjdat Balkan,; Salomone Di Saverio,; Stefan, S.; Santoro Giulio Aniello,; See Boon Keong,; Semra Demirli Atici,; Subramaniam, S.; Seon Hahn Kim,; Efetov, S.; Sergio, M.N.; Sevcan Arzu Arinkan,; Leventoglu, S.; Shaikh, S.; Middleton, S.; Manfredelli, S.; Basu, S.; Christodoulou, S.; Dritsas, S.; D'Ugo, S.; Bogdan, S.; Kapiris, S.; Karn, S.; Krivan, S.; Tamás, S.; Colak, T.; Tevfik Kıvılcım Uprak,; Petropoulou, T.; Sidiropoulos, T.; Tigabu Daniel Ayase,; Koëter, T.; Dominioni, T.; Fontana, T.; Violante, T.; Gwaram, U.; Ebochue, U.; Calu, V.; Munikrishnan, V.; Sud, V.; Vigorita, V.; Bellato, V.; Bresadola, V.; Aliyev, V.; Dar, W.; Zafar Ahmed Khan,; Şenol, Z.; Zainab Obaid Jaddoa,; Nikolaos, Z.; Yankai, Z.; Garoufalia, Z.; Zubair Ud Din,; Apollon, Z.; Anestiadou, Ε.; Harish Neelamraju Lakshmi,; Nefeli-Kaiti, T.; Mehmet Ayhan Kuzu,; Paola De Nardi,; Iryivuze, O.; Dhaygude, S.; Nadzlee Harith Bin Paisol,; Rauf, S.; Tsepov, D.; Hasan, M.; Alberts, J.; Akshay Bavikatte Prasannakumar,; Turu, D.; Adam, A.; Yesildal, C.; Eltyeb, H.; Baeza-Ibáñez, P.; Azharuddhin, M.; Amhaimed, A.; Claudia Alejandra Antón Velez,; Et-Tayab, O.; Speake, W.; Emre Furkan Kirkan,; Mishra, M.; Paraskevopoulos, I.; Picardi, B.; Braulio Francisco Reyes Méndez,; Bako, V.; Deryol, R.; Henok Teshome Ayele,

doi:10.1111/codi.70134

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.

Head‐down tilt lithotomy position and well‐leg compartment syndrome: An international survey of current practice / C. C Uzoma, A. I Shepherd, Z. L Saynor, J. S Khan, G. Niccolò Piozzi, R. Duhoky, C. Askew, M. Mahir Ozmen, T.R. F Middleton, S. Masum, M. Perissiou, A. Giri Goswami, A. Aziz, A. Elnour, A. Ndong, A. Fattah Bin Abdul Hamid, A. Khan, A. Musa Kulfi, A. Mylonakis, A. Adeyeye, A. Liceaga Fuentes, A. Miknevičiūtė, A. Hassouneh, A. El-Hussuna, A. Berhe Aregawi, A. Aiolfi, A. Arezzo, A. Ignacio Herrando, A. Vannelli, A. Malagnino, A. Julianov, A. Kozadinos, A. Theodorou, A. Cihat Yildirim, A. Guner, A. Malik, A. Yasen Mohamedahmed, A. Bulut, A. Antonelli, A. Botros, A. Ahmed Mureb, A. Dzulkarnaen Zakaria, A. Divizia, A. Martina Guida, A. Romanzi, A. A Gumbs, A. Craig Lynch, A. Day, A. Alessandro Marra, A. Parello, A. Paspala, A. Lin, A. Castaldi, A. Luberto, A. Simone Laganà, A. Koutras, A. Picciariello, A. Ioannidis, A. Papadopoulos, A. Rashid, A. Ali Kerawala, A. Marinis, A. Pantelis, A. Syllaios, A. Acheson, A. Saklani, A. Babajide Oladayo, B. Kobalava, B. Hemmelova, B. Drago, B. Yohannes, B. Sebastian, C. Ratto, C. Pattacini Gianmaria, C. Emir Guldogan, C. Ionut Ciubotaru, C. Innocent Onyeze, C. Agbo Agbo, C. Bali, C. Fleming, C. Kontopoulou, C. Chouliaras, C. Benlice, C. Tatar, C. Akyol, C. Coco, C. Peirce, C. Nastos, C. Gallardo, C. Huscher, D. Wright, D. Wilby, D. Brogden, D. Verdi, D. Merlini, D. Watt, D. Pertile, D. Burke, D. Markos, D. Sasia, D. Ntourakis, D. Papaconstantinou, D. Tsapralis, D. P Korkolis, D. Chrysikos, D. Carrola Gomes, D. Bowley, D. Dardanov, E. Billmann Thorgersen, E. Ozdemir, E. Jabber Kadhim, E. Spartalis, E. Andriopoluou, E. Reitano, E. Li, E. Van Eetvelde, E. Akpo, E. Gonullu, E. Gunay, E. Tekin, E. Harrison, E. Murat Yilmaz, F. Sammartano, F. Yi Cheung, F. Huda, F. Di Marco, F. Aljarad, F. Carannante, F. Hayati, F. Boudewijn Poelmann, F. Decebal, F. Dixon, F. Bianco, F. Pata, G. Arroyo Murillo, G. Marchitelli, G. H Van Van Ramshorst, G. Colletti, G. Paramasvaran, G. Fragulidis, G. Rallis, G. Stravodimos, G. David, G. Calini, G. Carganico, G. Formisano, G. Cassese, G. Pellino, G. Bogani, G. Dalmonte, G. Lisi, G. Cestaro, G. Turri, G. Brisinda, G. Cucinella, G. Frazzetta, G. P Martin-Martin, H. Olufemi Gbenga, H. Kerim Karakullukcu, H. Krentel, H. Mukhtar, H. E Elmansi Abdalla, H. Kumar Mangal, H. Elfeki, I. Daniels, I. Darwich, I. Umar Garzali, I. Kelvin Egbuchulem, I. Merlini, İ. Ismayilov, İ. Turan, I. Katsaros, I. Virlos, I. Negoi, I. Ahmed, J. Andreuccetti, J. Glasbey, J. Olivier, J. Wheeler, J. Ahmed, J. Cagaš, J. Torkington, J. Sagar, J. Meyer, J. Yuen-Chun Teoh, J. Jiun Mah, J. Afam-Osemene, J. Lee, J. P Bulte, J. Mathew, J. Davies, K. Sahnan, K. Malhotra, K. Gunasekare, K. Erdinç Kamer, K. Rida, K. C Vasileios, K. Apostolou, K. Bouchagier, K. Kopanakis, K. Stratakis, K. Mikhail, K. Jourand, K. Khobragade, L. Bhagya Samarakoon, L. Bashir Oladimeji, L. Siragusa, L. Dimitrios, L. Victor, L. Domenico Bonomo, L. Pio, L. Taglietti, L. Battaglia, L. Bonavina, M. Muneer Khan, M. A West, M. Cannistra, M. Catarci, M. Giacometti, M. Chiara Sighinolfi, M. Papadoliopoulou, M. Sotiropoulou, M. Trompetto, M. Kryzauskas, M. T Paraoan, M. A Potter, M. R Brincat, M. Spalluto, M. Rutegård, M. Podda, M. Frountzas, M. Ali Koç, M. Ömer Özduman, M. Kedir Abdella, M. Guler, M. Spartalis, M. Vailas, M. Adamina, M. Ballabio, M. A Thaha, M. Arif Hameed Sultan, M. Ebrahim, M. Faraz Khan, M. Basheeruddin Inamdar, M. Eid, M. Raj Thanapal, M. Syakir Mohd Azahar, M. Andrea, M. Shalaby, M. Nur Syamim Bin Che Johan, M. Salman Shafique, M. Shamim, M. Umar Younis, M. Ergenç, M. Duke George, M. Kalin, M. Yener Uzunoglu, N. Cigdem Arslan, N. Evaldas Samalavicius, N. Curtis, N. Kumar, N. Thanh Sang, N. Wong, N. Cinardi, N. De'Angelis, N. Flamey, N. Tamini, N. Chatzizacharias, N. Koliakos, N. Machairas, N. V Michalopoulos, N. Eli, N. Kızıltoprak, N. Okkabaz, N. Akinbami, O. Hyginus Ekwunife, O. Faruk Ozkan, O. Yalkin, O. Irowa, O. Yalav, O. Ioannidis, P. Milito, P. Vassiliu, P. Delrio, P. Herzog, P. Tejedor, P. Okeny, P. Ihnát, P. Ikponmwosa Agbonrofo, P. Vlček, P. H Pucher, P. Fransvea, P. Naik, P. Thambi, P. Wichendu, R. Mckinney, R. Garatea Grau, R. Sanchez Salas, R. Galleano, R. Izquierdo, R. Peravali, R. Aoun, R. Aggarwal, R. Reid, R. Isaacs, R. Carlo Colombari Monteiro, R. Gomes Campanati, R. Patel, R. Sampietro, R. Crolla, R. R Cabantac 3rd, R. Mbiine, R. Domínguez Azuaga, S. Oyewale, S. Pankajavihar Sasi, S. Müjdat Balkan, S. Di Saverio, S. Stefan, S. Giulio Aniello, S. Boon Keong, S. Demirli Atici, S. Subramaniam, S. Hahn Kim, S. Efetov, S. M Navarro, S. Arzu Arinkan, S. Leventoglu, S. Shaikh, S. Middleton, S. Manfredelli, S. Basu, S. Christodoulou, S. Dritsas, S. D'Ugo, S. Bogdan, S. Kapiris, S. Karn, S. Krivan, S. Tamás, T. Colak, T. Kıvılcım Uprak, T. Petropoulou, T. Sidiropoulos, T. Daniel Ayase, T. Koëter, T. Dominioni, T. Fontana, T. Violante, U. Gwaram, U. Ebochue, V. Calu, V. Munikrishnan, V. Sud, V. Vigorita, V. Bellato, V. Bresadola, V. Aliyev, W. Dar, Z. Ahmed Khan, Z. Şenol, Z. Obaid Jaddoa, Z. Nikolaos, Z. Yankai, Z. Garoufalia, Z. Ud Din, Z. Apollon, Ε. Anestiadou, H. Neelamraju Lakshmi, T. Nefeli-Kaiti, M. Ayhan Kuzu, P. De Nardi, O. Iryivuze, S. Dhaygude, N. Harith Bin Paisol, S. Rauf, D. Tsepov, M. Hasan, J. Alberts, A. Bavikatte Prasannakumar, D. Turu, A. Adam, C. Yesildal, H. Eltyeb, P. Baeza-Ibáñez, M. Azharuddhin, A. Amhaimed, C. Alejandra Antón Velez, O. Et-Tayab, W. Speake, E. Furkan Kirkan, M. Mishra, I. Paraskevopoulos, B. Picardi, B. Francisco Reyes Méndez, V. Bako, R. Deryol, H. Teshome Ayele. - In: COLORECTAL DISEASE. - ISSN 1462-8910. - 27:6(2025 Jun), pp. e70134.1-e70134.9. [10.1111/codi.70134]

Head‐down tilt lithotomy position and well‐leg compartment syndrome: An international survey of current practice

Chukwuemeka C Uzoma;Anthony I Shepherd;Zoe L Saynor;Jim S Khan;Guglielmo Niccolò Piozzi;Rauand Duhoky;Christopher Askew;M Mahir Ozmen;Thierry R F Middleton;Shamsul Masum;Maria Perissiou;Aakansha Giri Goswami;Aamir Aziz;Abdolazeem Elnour;Abdourahmane Ndong;Abdul Fattah Bin Abdul Hamid;Abdullah Khan;Abdullahi Musa Kulfi;Adam Mylonakis;Ademola Adeyeye;Adriana Liceaga Fuentes;Agnė Miknevičiūtė;Ala Hassouneh;Alaa El-Hussuna;Alazar Berhe Aregawi;A. Aiolfi;Alberto Arezzo;Alberto Ignacio Herrando;Alberto Vannelli;A. Malagnino;Alexander Julianov;Alexandros Kozadinos;Alexis Theodorou;Ali Cihat Yildirim;Ali Guner;Ali Malik;Ali Yasen Mohamedahmed;Alisina Bulut;Amedeo Antonelli;Amir Botros;Amro Ahmed Mureb;Andee Dzulkarnaen Zakaria;Andrea Divizia;Andrea Martina Guida;Andrea Romanzi;Andrew A Gumbs;Andrew Craig Lynch;Andrew Day;Angelo Alessandro Marra;Angelo Parello;Anna Paspala;Anthony Lin;Antonio Castaldi;Antonio Luberto;Antonio Simone Laganà;Antonios Koutras;Arcangelo Picciariello;Argyrios Ioannidis;Aristeidis Papadopoulos;Arshad Rashid;Asad Ali Kerawala;Athanasios Marinis;Athanasios Pantelis;Athanasios Syllaios;Austin Acheson;Avanish Saklani;Ayandele Babajide Oladayo;Badri Kobalava;Beata Hemmelova;Beatrice Drago;Binyam Yohannes;Boby Sebastian;Carlo Ratto;Casoni Pattacini Gianmaria;Cem Emir Guldogan;Cezar Ionut Ciubotaru;Chigozie Innocent Onyeze;Christian Agbo Agbo;Christina Bali;Christina Fleming;Christina Kontopoulou;Christos Chouliaras;Cigdem Benlice;Cihad Tatar;Cihangir Akyol;Claudio Coco;Colin Peirce;Constantinos Nastos;Cristian Gallardo;Cristiano Huscher;Danette Wright;Daniel Wilby;Danielle Brogden;Daunia Verdi;David Merlini;David Watt;Davide Pertile;Dermot Burke;Despotidis Markos;Diego Sasia;Dimitrios Ntourakis;Dimitrios Papaconstantinou;Dimitrios Tsapralis;Dimitris P Korkolis;Dimosthenis Chrysikos;Diogo Carrola Gomes;Douglas Bowley;Dragomir Dardanov;Ebbe Billmann Thorgersen;Egemen Ozdemir;Ekhlas Jabber Kadhim;Eleftherios Spartalis;Eleni Andriopoluou;E. Reitano;Elizabeth Li;Ellen Van Eetvelde;Emmanuel Akpo;Emre Gonullu;Emre Gunay;Enver Tekin;Ewen Harrison;Eyup Murat Yilmaz;F. Sammartano;Fang Yi Cheung;Farhanul Huda;Federica Di Marco;Feras AlJarad;Filippo Carannante;Firdaus Hayati;Floris Boudewijn Poelmann;Fodor Decebal;Frances Dixon;Francesco Bianco;Francesco Pata;Gabriela Arroyo Murillo;Gabriella Marchitelli;Gabrielle H van van Ramshorst;G. Colletti;Ganendra Paramasvaran;Georgios Fragulidis;Georgios Rallis;Georgios Stravodimos;Gerald David;Giacomo Calini;Giacomo Carganico;G. Formisano;Gianluca Cassese;Gianluca Pellino;Giorgio Bogani;Giorgio Dalmonte;Giorgio Lisi;Giovanni Cestaro;Giulia Turri;Giuseppe Brisinda;Giuseppe Cucinella;Giuseppe Frazzetta;Gonzalo P Martin-Martin;Habeeb Olufemi Gbenga;Haluk Kerim Karakullukcu;Harald Krentel;Hasan Mukhtar;Hashim E Elmansi Abdalla;Hemendra Kumar Mangal;Hossam Elfeki;Ian Daniels;Ibrahim Darwich;Ibrahim Umar Garzali;Ifeanyichukwu Kelvin Egbuchulem;Ilenia Merlini;İlgar Ismayilov;İlknur Turan;Ioannis Katsaros;Ioannis Virlos;Ionut Negoi;Irfan Ahmed;Jacopo Andreuccetti;James Glasbey;James Olivier;James Wheeler;Jamil Ahmed;Jan Cagaš;Jared Torkington;Jayesh Sagar;Jeremy Meyer;Jeremy Yuen-Chun Teoh;Jin Jiun Mah;John Afam-Osemene;Jonathan Lee;Joris P Bulte;Joseph Mathew;Justin Davies;Kapil Sahnan;Kashish Malhotra;Kaushika Gunasekare;Kemal Erdinç Kamer;Khaled Rida;Kollaras C Vasileios;Konstantinos Apostolou;Konstantinos Bouchagier;Konstantinos Kopanakis;Konstantinos Stratakis;Kosachenko Mikhail;Kris Jourand;Krunal Khobragade;Lasitha Bhagya Samarakoon;Lawal Bashir Oladimeji;Leandro Siragusa;Linardoutsos Dimitrios;Lopez-Lopez Victor;Luca Domenico Bonomo;Luca Pio;Lucio Taglietti;Luigi Battaglia;L. Bonavina;Mah Muneer Khan;Malcolm A West;Marco Cannistra;Marco Catarci;Marco Giacometti;Maria Chiara Sighinolfi;Maria Papadoliopoulou;Maria Sotiropoulou;Mario Trompetto;Marius Kryzauskas;Marius T Paraoan;Mark A Potter;Mark R Brincat;M. Spalluto;Martin Rutegård;M. Podda;Maximos Frountzas;Mehmet Ali Koç;Mehmet Ömer Özduman;Mejudin Kedir Abdella;Mert Guler;Michael Spartalis;Michail Vailas;Michel Adamina;M. Ballabio;Mohamed A Thaha;Mohamed Arif Hameed Sultan;Mohamed Ebrahim;Mohammad Faraz Khan;Mohammed Basheeruddin Inamdar;Mohammed Eid;Mohana Raj Thanapal;Mohd Syakir Mohd Azahar;Morini Andrea;Mostafa Shalaby;Muhammad Nur Syamim Bin Che Johan;Muhammad Salman Shafique;Muhammad Shamim;Muhammad Umar Younis;Muhammer Ergenç;Mukoro Duke George;Murat Kalin;Mustafa Yener Uzunoglu;Naciye Cigdem Arslan;Narimantas Evaldas Samalavicius;Nathan Curtis;Navin Kumar;Nguyen Thanh Sang;Nicholas Wong;Nicola Cinardi;Nicola de'Angelis;Nicolas Flamey;Nicolò Tamini;Nikolaos Chatzizacharias;Nikolaos Koliakos;Nikolaos Machairas;Nikolaos V Michalopoulos;Nnaemeka Eli;Nurhilal Kızıltoprak;Nuri Okkabaz;Nurudeen Akinbami;Okechukwu Hyginus Ekwunife;Omer Faruk Ozkan;Omer Yalkin;Omorodion Irowa;Orçun Yalav;Orestis Ioannidis;P. Milito;Panteleimon Vassiliu;Paolo Delrio;Pascal Herzog;Patricia Tejedor;Paul Okeny;Peter Ihnát;Peter Ikponmwosa Agbonrofo;Petr Vlček;Philip H Pucher;Pietro Fransvea;Prashant Naik;Prem Thambi;Promise Wichendu;Rachel McKinney;Rafael Garatea Grau;Rafael Sanchez Salas;Raffaele Galleano;Raimundo Izquierdo;Rajeev Peravali;Rany Aoun;Ravi Aggarwal;Rebecca Reid;Reinaldo Isaacs;Renan Carlo Colombari Monteiro;Renato Gomes Campanati;Rikesh Patel;Roberto Sampietro;Rogier Crolla;Romulo R Cabantac 3rd;Ronald Mbiine;Rubén Domínguez Azuaga;Saburi Oyewale;Sajith Pankajavihar Sasi;Salih Müjdat Balkan;Salomone Di Saverio;Samuel Stefan;Santoro Giulio Aniello;See Boon Keong;Semra Demirli Atici;Sentilnathan Subramaniam;Seon Hahn Kim;Sergey Efetov;Sergio M Navarro;Sevcan Arzu Arinkan;Sezai Leventoglu;Shafaque Shaikh;Simon Middleton;Simone Manfredelli;Somprakas Basu;Spyridon Christodoulou;Spyridon Dritsas;Stefano D'Ugo;Stoica Bogdan;Stylianos Kapiris;Summi Karn;Sylvia Krivan;Sztipits Tamás;Tahsin Colak;Tevfik Kıvılcım Uprak;Thalia Petropoulou;Theodoros Sidiropoulos;Tigabu Daniel Ayase;Tijmen Koëter;Tommaso Dominioni;Tommaso Fontana;Tommaso Violante;Usman Gwaram;Uzochi Ebochue;Valentin Calu;Venkatesh Munikrishnan;Vikas Sud;Vincenzo Vigorita;Vittoria Bellato;Vittorio Bresadola;Vusal Aliyev;Wasim Dar;Zafar Ahmed Khan;Zafer Şenol;Zainab Obaid Jaddoa;Zampitis Nikolaos;Zhang Yankai;Zoe Garoufalia;Zubair Ud Din;Zygomalas Apollon;Εlissavet Anestiadou;Harish Neelamraju Lakshmi;Tomara Nefeli-Kaiti;Mehmet Ayhan Kuzu;Paola De Nardi;Olivier Iryivuze;Sudhir Dhaygude;Nadzlee Harith Bin Paisol;Sidra Rauf;Denis Tsepov;Mahmudul Hasan;Justin Alberts;Akshay Bavikatte Prasannakumar;Dorottya Turu;Ahmed Adam;Cumhur Yesildal;Hazim Eltyeb;Pablo Baeza-Ibáñez;Mohd Azharuddhin;Ahmad Amhaimed;Claudia Alejandra Antón Velez;Ouazzani Et-Tayab;William Speake;Emre Furkan Kirkan;Megha Mishra;Ioannis Paraskevopoulos;Biagio Picardi;Braulio Francisco Reyes Méndez;Victor Bako;Riza Deryol;Henok Teshome Ayele

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.

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	Parole chiave
	
				Lloyd‐Davies; compartment syndrome; global survey; perioperative practices; prevention and management; robotic surgery
			
	Settori scientifico-disciplinari dell'articolo (validi dal 09/05/2024)
	
				Settore MEDS-06/A - Chirurgia generale
			
	Data di pubblicazione
	
				giu-2025
			
	Rivista in ANCE
	
				COLORECTAL DISEASE
			
	DOI
	
				https://dx.doi.org/10.1111/codi.70134
			
	Tipologia
	
				Article (author)
			
	Appare nelle tipologie:
	
				01 - Articolo su periodico

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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1205377

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