Lower leg compartment syndrome after laparoscopic intestinal resection: A series of 3 cases

Well leg compartment syndrome (WLCS) is an infrequent but potentially lethal complication of the lithotomy position during surgery. If the diagnosis and/ or treatment are delayed it may lead to severe conditions such as irreversible nerve injury, renal failure and multi-organ failure. Decreased perfusion pressure of the limb due to lithotomy and Trendelenburg position and increased intramuscular pressure of the calf due to external compression are likely to contribute to the development of WLCS. At our institution, preventive measures were undertaken to reduce the risk of WLCS : 1) the patient was placed in the lithotomy position with minimal elevation of the ankles and minimal compression to the calves, and 2) head-down tilt was discontinued every 2-3 hours. Despite these preventive measures, we experienced three cases of WLCS after laparoscopic intestinal resection Through this experience, we introduced changes to the preventive measures : 1) head-down tilt should be discontinued every 2 hours for 5 minutes, 2) knee flexion should be minimal when placed in the lithotomy position, and 3) legs should be placed in a heel-supported position in the well-leg holder. Complete prevention of WLCS is still a great challenge, and thus, we will have to evaluate the efficacy of our new approach.