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Analysis of external pressure on the left calf in the Lloyd–Davies position during colorectal surgery

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Abstract

Purpose

Well-leg compartment syndrome (WLCS) is a potentially life-threatening postoperative complication related to the Lloyd–Davies surgical position, which can place increased external pressure on the calf region. We conducted this study to analyze external pressure changes, by applying a leg holder system to the left calf region of patients placed in the Lloyd–Davies position during laparoscopic surgery.

Methods

The study participants were 50 patients who underwent laparoscopic surgery for colorectal cancer in the Lloyd–Davies position. We assessed the maximum external pressure (MEP) on the left calf region using a pressure-distribution measurement system. Intraoperative measurements were taken continuously, and the MEP was evaluated with the patient horizontal and every 30 min during surgery in the head and right-down tilt position.

Results

The intraoperative MEP increased gradually when the patient was in the head and right-down tilt position and decreased when the patient was returned to the horizontal position. The MEP was higher in patients aged < 60 years, those who were obese, and those with a thick calf circumference. Both body mass index (BMI) and the maximum left calf circumference (MLCC) were found to correlate with the MEP.

Conclusions

In addition to a high BMI, which is a well-known risk factor for WLCS, a high MLCC should be considered another risk factor, especially for patients under 60 years.

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Funding

There was no specific funding for this work.

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Authors and Affiliations

  1. Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan

    Katsunori Suzuki, Mayu Sakata, Kyota Tatsuta, Kosuke Sugiyama, Toshiya Akai, Yuhi Suzuki, Takafumi Kawamura, Yoshifumi Morita, Hirotoshi Kikuchi, Yoshihiro Hiramatsu, Masayoshi Yamamoto, Kiyotaka Kurachi, Takanori Sakaguchi & Hiroya Takeuchi

  2. First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Kakeru Torii

  3. Department of Gastroenterological Surgery, Iwata City Hospital, Iwata, Shizuoka, Japan

    Atsuko Fukazawa & Takanori Sakaguchi

Authors
  1. Katsunori Suzuki
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  2. Mayu Sakata
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  3. Kyota Tatsuta
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  14. Kiyotaka Kurachi
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  15. Takanori Sakaguchi
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  16. Hiroya Takeuchi
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Corresponding author

Correspondence to Kiyotaka Kurachi.

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We have no conflicts of interest to declare.

Statements Regarding Ethics and Consent

This single-arm prospective study was approved by the Ethics Committee of our University (Institutional Review Board approval # E18-002). Written informed consent to participate in the study was obtained from all patients.

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Suzuki, K., Sakata, M., Tatsuta, K. et al. Analysis of external pressure on the left calf in the Lloyd–Davies position during colorectal surgery. Surg Today 53, 145–152 (2023). https://doi.org/10.1007/s00595-022-02549-w

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  • DOI: https://doi.org/10.1007/s00595-022-02549-w

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