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Survey of compartment syndrome of the lower extremity after gynecological operations

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Abstract

Purpose

This study was aimed to investigate incidence, circumstances and consequences of acute compartment syndrome (CS) of the lower extremity after gynecological operations in lithotomy position by collecting data from departments of Obstetrics and Gynecology in Germany.

Design

Retrospective observational study.

Setting

Departments of Obstetrics and Gynecology in the area of North Rhine (Germany)

Methods

A 24-item questionnaire was sent to 168 gynecological departments. In addition, cases anonymously reported to the Expert Committee for Medical Malpractice Claims of the Medical Association of North Rhine between 2002 and 2012 were analyzed.

Main outcome measure

Incidence of acute CS after gynecological operations.

Results

A total of 59 questionnaires (35 %) were returned for analysis, reporting 21 cases of CS. Based on the collected data, we calculated an incidence of postoperative CS ranging between 0.067 % and 0.28 %. All reported cases of postoperative CS occurred after surgeries in lithotomy position, 57.1 % of cases occurred after laparoscopic procedures and 76.2 % after procedures longer than 4 h. Overall, 61.0 % of departments do not routinely inform about the risk of this complication when they get patients’ informed consent. Reported prevention strategies were inconsistent and ranged from none to multiple measures.

Conclusion

CS is a complication clearly associated with long lasting gynecological operations in Lithotomy position. Despite a relatively high incidence, so far no guidelines on perioperative management and medicolegal aspects exist and preventive measures are heterogeneous among institutions. The need for guidelines and recommendations by an expert committee has been identified.

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Abbreviations

AEKNO:

Medical Association of North Rhine

BMI:

Body mass index

CS:

Compartment syndrome

ICP:

Intra-compartmental pressure

LAP:

Laparotomy

LSC:

Laparoscopy

LT:

Lithotomy

Ob&Gyn:

Obstetrics and Gynecology

WLCS:

Well leg compartment syndrome

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Acknowledgments

We thank Dr. Weber from the Medical association North Rhine (AEKNO) for her support.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany

    Emanuel C. A. Bauer & Wolfgang Janni

  2. Department of Obstetrics and Gynecology, Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany

    Nicolina Koch, Hans G. Bender & Markus C. Fleisch

  3. Department of Traumatology and Orthopedics, Trauma Center Murnau, Murnau, Germany

    Christoph J. Erichsen

  4. Department of Anaesthesiology, Heinrich Heine University, Duesseldorf, Germany

    Tobias Juettner

  5. Department of Obstetrics and Gynecology, St. Elisabeth Hospital, Cologne, Germany

    Daniel Rein

Authors
  1. Emanuel C. A. Bauer
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  2. Nicolina Koch
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  3. Christoph J. Erichsen
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  4. Tobias Juettner
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  5. Daniel Rein
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  6. Wolfgang Janni
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  7. Hans G. Bender
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  8. Markus C. Fleisch
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Corresponding author

Correspondence to Markus C. Fleisch.

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Bauer, E.C.A., Koch, N., Erichsen, C.J. et al. Survey of compartment syndrome of the lower extremity after gynecological operations. Langenbecks Arch Surg 399, 343–348 (2014). https://doi.org/10.1007/s00423-014-1172-z

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  • DOI: https://doi.org/10.1007/s00423-014-1172-z

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