Lessons to Learn From 36 Cases of Well-Leg Compartment Syndrome in Colorectal Surgery: A Systematic Literature Review

Well-leg compartment syndrome is a rare and severe complication that occurs after prolonged surgery in the lithotomy position. This review outlines the presentation, diagnosis, and management of well-leg compartment syndrome after colorectal surgery. A comprehensive and systematic search of various electronic databases was conducted. All case reports and case series of well-leg compartment syndrome after colorectal surgery were included. Patient demographics, operative details, presenting symptoms, investigations, management, and treatment outcomes were collected from the eligible reports. Twenty-three articles, reporting a total of 36 patients, were eligible for inclusion in this review. Most of the included patients were male (88.9%), with an age range of 7-74 years. All reported cases in this review were placed in lithotomy position variations (standard lithotomy, Lloyd-Davies, and modified lithotomy) with an operative time exceeding four hours. Moreover, the presenting symptoms were lower limb pain, swelling, and loss of sensation on postoperative days 0 and 1. Fasciotomy was performed in 88.9% of cases, and half of the patients developed permanent sensory or motor dysfunction in the lower limbs. In conclusion, well-leg compartment syndrome is a rare, devastating complication that may result in permanent sensory or motor dysfunction. Early diagnosis and management are paramount for preserving limb function and optimising patient outcomes.