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Neurovascular morbidity from the lithotomy position

R Kubiak1, D T Wilcox, L Spitz

  • 1Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Trust, London, England.

Journal of Pediatric Surgery
|December 30, 1998
PubMed
Summary
This summary is machine-generated.

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Prolonged use of the lithotomy position in pediatric surgery can lead to serious lower limb complications, including nerve injury and compartment syndrome. Minimizing time in this position may help prevent these adverse neurovascular events.

Area of Science:

  • Pediatric Surgery
  • Orthopedic Surgery
  • Vascular Surgery

Background:

  • The lithotomy position is utilized in pediatric surgery for procedures requiring simultaneous abdominal and perineal access.
  • This position involves specific patient positioning that may pose risks if maintained for extended durations.

Observation:

  • Four pediatric patients experienced significant lower limb complications after prolonged periods in the lithotomy position.
  • Complications included sciatic nerve injury, deep venous thrombosis, and bilateral compartment syndrome with myonecrosis.

Findings:

  • A correlation exists between extended duration in the lithotomy position and the occurrence of postoperative neurovascular complications in pediatric patients.
  • Specific procedures associated with these complications included redo Duhamel procedure, anorectal leiomyoma excision, and ileoanal anastomosis.

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Implications:

  • Careful consideration of operative positioning is crucial in pediatric surgery.
  • Limiting the duration of the lithotomy position to periods strictly necessary for perineal access may mitigate the risk of severe neurovascular injuries.