Trendelenburg Position

TRENDELENBURG POSITION (Trendelenburg) was introduced by Trendelenburg for abdominal operations on pelvic organs. In this position, the pelvis is elevated above the upper half of the body due to the tilting of the operating table. The Trendelenburg position is of great importance for operations on pelvic organs, as it causes the abdominal viscera to shift upward toward the diaphragm, thereby expanding access to the surgical field. The Trendelenburg position is ineffective in obese subjects, a point which Trendelenburg himself indicated at the time. Some authors consider the Trendelenburg position unsafe. Kraske pointed out that in this position, acute cardiac dilation may occur in individuals with an inadequate heart muscle, as well as intestinal volvulus in obese subjects due to prolonged displacement of the viscera. Eiselsberg, Rotter, and others observed cerebral hemorrhages with prolonged Trendelenburg position, but all these complications are so rare that they cannot diminish the value of the Trendelenburg position. Nevertheless, for the prevention of such complications, the patient should be placed in the Trendelenburg position gradually, not suddenly, and at the same time the duration of the patient's stay in this position should be limited. For operations on abdominal organs, before closing the abdomen, the patient should be taken out of the tilted position, whereby the air accumulated in the abdominal cavity escapes and the viscera return to their previous position. The Trendelenburg position is created by special devices for operating tables (see Operating tables). The construction of the latter should ensure easy and rapid change of the patient's position during the operation. This can be achieved not only with the help of improved mechanisms, which are characteristic of the latest models of tables, but also with the help of simple devices. Very convenient and at the same time simple is the Delage table (see the illustration in the article Operating tables).