Peripheral Neuropathy after Open Abdominal Surgery with Self-Retaining Retractors. A Systematic Review of Randomised and Non-Randomised Clinical Trials

Prathima Chowdary,Monika Baumann

doi:10.4236/ojog.2017.78081

Abstract

Objectives : A systematic review was undertaken to evaluate the effectiveness of incision retention available to surgeons conducting open abdominal or pelvic surgeries. Both the ability of the retractor to retain the wound and harm to the patient due to the retractor were reviewed. Methods : A search was conducted using the following databases: EMBASE, PubMed, BIOSIS, Engineering Village, Web of Science, Best practice, Science Direct, CRCnet BASE, Proquest, Wiley Online Library, and Comprehensive Biomaterial. Results : What the articles found were then narrowed down to those which matched the objective of the review. This resulted in ten articles to review. Two reviewers reviewed and summarized the articles. Femoral neuropathy was found to be a common complication due to Retractors. Other outcomes analysed or studied were found to be infected, postoperative pain and exposure provided. Femoral neuropathy can be estimated to occur at a rate between 2.6% and 7.5% in open pelvic and abdominal surgeries. The Alexis O-ring retractor was found to lower the required morphine intake following surgery when compared to the Belfour retractor. Conclusions : There is a lack of high quality/high levels of evidence studies that have been conducted on Retractors. Femoral neuropathy is the outcome most commonly documented in relation to Retractors. Surgeons need to be aware about the use and implementations of the retractors. Care should be taken in protecting the blades and during long surgery relocating retractors should be considered.

Highlights

Iatrogenic femoral neuropathy following pelvic surgery has been known since the late 1800s
A systematic review was undertaken to evaluate the effectiveness of incision retention available to surgeons conducting open abdominal or pelvic surgeries
Femoral neuropathy and other problems caused by the nerves were the areas of main focus, though some comments and review has been performed involving the universal purpose of the Retractors and the benefits and ease of them

Summary

Introduction

Iatrogenic femoral neuropathy following pelvic surgery has been known since the late 1800s. Pathogenesis is attributed to the continuous pressure exerted by the various self-retaining retractors on the pelvic sidewall and the psoas muscle. The femoral nerve is the largest branch of the lumbar plexus arising from the dorsal divisions of the ventral rami of the second, third and fourth lumbar nerves. It comes down through the psoas muscle approximately 4 cm above the inguinal ligament. It at all times remains in the operative field of the surgeon who operates in the abdomen and pelvis. There is a relatively poor blood supply to the femoral nerve as it crosses the pelvis and is susceptible to ischemia

Objectives

Methods

Results

Discussion

Conclusion