Neurovascular morbidity from the lithotomy position

The lithotomy position is used in pediatric surgery when it is necessary to have simultaneous access to the abdomen and perineum. At the authors' inst itution, after a prolonged period in the lithotomy position, significant lo wer limb complications developed in four patients. Two patients with Hirsch sprung's disease underwent a redo Duhamel procedure, one had an anorectal l eiomyoma excised, and one had an ileoanal anastomosis for ulcerative coliti s. Sciatic nerve injury developed in two patients and deep venous thrombosi s and bilateral compartment syndrome resulting in myonecrosis developed in one each. There is an association between operations that require prolonged lithotomy position and the development of postoperative neurovascular comp lications. By placing the child in the lithotomy position only when access to the perineum is required, these significant injuries may be avoided. J P ediatr Surg 33:1808-1810. Copyright (C) 1998 by W.B. Saunders Company.