What is the position of choice for a low anterior colon resection?

Abstract

Intra-operative positioning in colorectal surgery is very important from 3 points of view: the proper surgical approach and exposure, adequate anaesthetic requirements with maintenance of the airway, and the potential complications related to the position. In the present study, we analyse the indications, positioning, advantages and disadvantages of each operative position, their potential complications and how to avoid them. These complications can be of a diverse nature, the most common being injuries related to stretching or compression of peripheral nerves, followed by thromboembolic, haemodynamic, and ischaemic or compartmental syndromes related to ischaemia-reperfusion after a long time in the Trendelenburg position. Anaesthetists and surgeons should coordinate and take responsibility for the position of surgical patients.

Keywords:

Operation positioning

Colorectal surgery

Jacknife position

Lithotomy-Trendelenburg position

Compartmental syndrome

Peripheral nerve lesions

Resumen

La posición operatoria en coloproctología es fundamental desde tres puntos de vista: correcto abordaje quirúrgico y exposición adecuada, requerimientos anestésicos y del mantenimiento de la vía aérea, y las complicaciones potenciales relacionadas con la propia posición. En el presente trabajo se revisan las indicaciones, colocación, ventajas e inconvenientes de cada posición operatoria, así como sus posibles complicaciones y cómo evitarlas. Éstas pueden ser de diversa índole, si bien las más frecuentes están relacionadas con lesiones por estiramiento o compresión de los nervios periféricos, seguidas por las tromboembólicas, hemodinámicas e isquémicas o síndromes compartimentales por isquemiareperfusión tras un largo periodo en posición de Trendelenburg. Anestesistas y cirujanos deben coordinar y responsabilizarse de la posición operatoria de los pacientes.

Palabras clave:

Posición operatoria

Cirugía colorrectal

Posición de navaja

Posición de litotomía-Trendelenburg

Síndrome compartimental

Lesiones de nervios periféricos

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