TITLE:
Peripheral Neuropathy after Open Abdominal Surgery with Self-Retaining Retractors. A Systematic Review of Randomised and Non-Randomised Clinical Trials
AUTHORS:
Prathima Chowdary, Monika Baumann
KEYWORDS:
Open, Abdominal, Pelvic, Surgery, Retraction, Nerve, Bowel, Urinary, Injury, Self-Retaining, Incision Retention
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.7 No.8,
August
2,
2017
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.