SP 6.10 International Multispecialty Delphi Consensus on Preventing Well-Leg Compartment Syndrome in Minimally Invasive Abdominopelvic Surgery
Chukwuemeka Uzoma, Peter Hertz, Guglielmo Niccolò Piozzi, Anthony Shepherd, Maria Perissiou, Jim KhanAbstract
Aims
Well-leg compartment syndrome (WLCS) is a rare but potentially devastating complication of abdominopelvic surgery performed in the head-down tilt lithotomy (HDTL) position. Limited awareness, under-recognition, and inconsistent reporting have hindered prevention and contributed to variation in perioperative practice. The HDTL-WLCS Delphi study aimed to establish consensus-based recommendations for the prevention and management of WLCS in abdominopelvic minimally invasive surgery (MIS).
Methods
A three-round iterative process was undertaken using evidence-informed statements evaluated by an international, multispecialty Delphi panel. Panellists (n=91) had a median of 15 years’ experience in MIS and HDTL and represented five stakeholder groups: general and colorectal surgeons (61; 67%), urologists and gynaecologists (8; 9%), anaesthetists/anaesthesiologists (8; 9%), surgical trainees/residents (10; 11%), and theatre/operating room staff (4; 4%). Consensus was predefined as ≥80% agreement (Likert scores 7–9).
Results
Consensus was achieved for 26 statements addressing: perioperative awareness and staff education; patient-specific risk assessment; team-based prevention strategies; standardised patient positioning; intraoperative leg monitoring and documentation; postoperative vigilance; timely recognition and diagnosis; and prompt definitive management of WLCS. Qualitative feedback highlighted the absence of a clear definition of “high-risk” patients and the need for a validated WLCS risk-stratification tool to support perioperative decision-making.
Conclusion
This study provides a comprehensive, actionable framework for standardising WLCS prevention and management in abdominopelvic MIS. Adoption of these recommendations into local standard operating procedures and perioperative pathways may reduce preventable morbidity and improve patient safety. Future research should prioritise risk stratification, prospective surveillance, and service evaluation to address remaining uncertainties.