The ilioinguinal approach versus the anterior intrapelvic. Acetabular fractures pose a great surgical challenge for orthopedic trauma surgeons. Newly modified stoppa approach for acetabular fractures. The uadrilateral surface is also visualized through this approach. To compare the efficacy of the operative techniques, complications, reduction quality and hip functional recovery by using the suprailioinguinal approach and the modified stoppa approach for the management of acetabular fractures. Ilioinguinal approach versus stoppa approach for open. The stoppa approach in hip revision surgery can be a complement to traditional approaches to control the. The modified stoppa approach is an intrapelvic approach initially used for inguinal hernia surgery by rives et al. Stoppa r, petit j, abourachid h, henry x, duclaye c, monchaux g, et al. The stoppa approach in its modified form is an intrapelvine approach for the treatment of acetabular fractures. It is performed by wrapping the lower part of the parietal peritoneum with prosthetic mesh and placing it at a preperitoneal level over fruchauds myopectineal orifice.
Cole and bolhofner described a modified stoppa approach through the rectus abdominus muscle for the treatment of fractures of the pelvic ring or acetabulum. Stoppa approach, an alternative for total hip arthroplasty in an intrapelvic cup. A modified stoppa technique approach for treatment of. Acetabular fractures are complex intraarticular fractures. The stoppa procedure is a very safe repair of bilateral inguinal hernia, but it requires a learning period to achieve optimal results. Dissection and ligation of the corona mortis is important to prevent bleeding black arrow. A consecutive cohort of 60 patients from september 2014 to october 2017 with displaced acetabular fractures involving the quadrilateral plate were treated. The extrapelvic ilioinguinal il has been the workhorse for the anterior approach and. The newly modified stoppa approach was performed to fix the acetabular fractures with main anterior displacement and the anterior and lateral. The modified stoppa approach provides the advantages of direct visualization of the entire pelvic brim from the pubic body to the anterior aspect of the sacral ala, direct visualization and. A randomized controlled clinical study was conducted to provide an. It has many advantages, particularly in cases of recurrent or multirecurrent inguinal hernias. Pdf treatment results for acetabulum fractures using the.
However, as both classical and type ii pareto distribu. On the contrary, stoppa approach belongs to the intrapelvic ones. Injury of the obturator nerve in the modified stoppa. Minimally invasive treatment of bothcolumn acetabular. Safety of modified stoppa approach for ganz periacetabular. Two hundred and ten patients with bilateral inguinal hernia 420 hernias were repaired with stoppa procedure from january 1995 to december 2003 with an average age of 57.
Thus, anterior component separation was developed to allow further myofascial advancement. Advance your surgical expertise with atlas of advanced operative surgery. Clinicoradiological outcomes of using modified stoppa approach. The stoppa procedure is a tensionfree type of hernia repair. They were followed up for at least 1 year postoperatively for radiographic and clinical assessments, which included the modified merle daubigne score, harris hip score, and pain visual analogue scale. Fixation of pelvicacetabular fractures using a midline. We herein present a case of an acetabulum anterior column posterior hemitransverse fracture following a traffic accident, which was treated surgically using a modified stoppa technique approach.
Ii distribution is one of three generalisations of the pareto. Recent studies have reported fewer complications and less morbidity from the stoppa approach 17, 18. Pdf we analyzed the extent of the comminution in the acetabular. Posterior component separationtransversus abdominis release. The entire internal iliac fossa as well as the pelvic brim are exposed. Modified rivesstoppa technique for repair of complex. The stoppa approach allows for pelvic damage control and reconstruction of bone defect. The major difference between the il and the stoppa approaches is that stoppa allows for the avoidance of the middle window of the il approach.
However, there is no clinical evidence to confirm its efficiency. The modified stoppa approach for acetabular fracture. Fracture acetabulum is a challenging, difficult to treat orthopedic injury due to its location and associated concomitant injuries. Suprailioinguinal versus modified stoppa approach in the. The stoppa gprvs procedure utilizes the many advantages of the preperitoneal approach in inguinal hernia repair. The surgical approach is dictated by the type of fracture and the main direction of dislocation. Goals are the gentle softtissue preparation, anatomic reduction and stable internal fixation. Therefore, minimally invasive surgery is more appropriate. This approach, described by hirvensalo 26 and later cole 27, is a modification of the intrapelvic approach described by stoppa et al. The primary modification of the primitive stoppa approach was the dissection performed laterally and posteriorly into the internal iliac fossa and the quadrilateral surface. Though it is primarily an approach to the anterior column a useful though less effective approach. We used a consecutive group of 29 adult patients with acetabular fractures treated operatively with a newly modified stoppa approach. Modified stoppa approach by cyril mauffrey duration. Compared to the modified stoppa approach, the suprailioinguinal approach provides a closer visualization to the.
The modified stoppa approach, otherwise known as the anterior intrapelvic approach aipa 26 to the anterior acetabulum and pelvis through an intrapelvic dissection from the midline, was first described in 1993 by hirvensalo 24, and later independently by cole in 1994 27, and has the. Our approach to the rivesstoppa technique springerlink. Introduction acetabular fractures are complex intraarticular fractures. Clinicoradiological outcomes of using modified stoppa. However, this approach is limited by the amount of myofascial advancement and sublay space available for a wide mesh overlap. The midline approach for hernia treatment with a complicated incision was first described by stoppa in 1989.
Operative approach according to the letournel and judet fracture type fracture type operative approach total modified stoppa % approach combined approach anterior column 6 0 6 27. We present our experience of using a newly modified stoppa approach combined with a lateral approach to the iliac crest in patients with acetabular fractures in reference to fracture reduction and fixation, technical aspects, and the incidence of complications. Single modified ilioinguinal approach for the treatment of. Stoppa procedure in bilateral inguinal hernia springerlink. The pararectus approach facilitates surgical access directly above the hip joint, which is comparable with the access obtained through the second window of the ilioinguinal approach, but without dissection of the inguinal canal.
Modified stoppa approach for fractures of the acetabulum cyril mauffrey, md on vimeo. Displaced acetabular fractures are intraarticular fractures of the weightbearing joints, and best treated through open reduction and internal fixation. Hence, the modified stoppa approach msa can be adopted by a. Most surgeons performing abdominalwall surgery consider the rives stoppa technique to be the gold standard procedure in the open treatment of. Stoppa approach for intrapelvic damage control and reconstruction. Acetabular fracture fixation via a modified stoppa limited i. Modified stoppa as an alternative surgical approach for. In this paper we will present our experience in using the stoppa approach. Clinical results of acetabular fracture management with the.
Modified stoppa approach for fractures of the acetabulum. The modified stoppa approach was introduced to manage fracture of the anterior column instead of the ilioinguinal approach to reduce morbidity. Treatment results for acetabulum fractures using the modified stoppa approach. Ilioinguinal approach versus stoppa approach for open reduction. Pdf modified stoppa approach for surgical treatment of. I distribution, defined by adding the shape parameter. Suprailioinguinal versus modified stoppa approach in the treatment. The stoppa approach can be applied successfully in anterior acetabulum and selected posterior surgery and satisfactory results can be obtained. This video describes a step by step approach to perform the reduction and fixation of acetabular fractures from the front.
Given the specificity of reduction and fixation process, each approach bears different advantages and disadvantages in treating displaced. The rives stoppa repair for complex incisional hernias confers the benefits of prosthetic repair and lower recurrence rates, but decreases certain complications by preventing direct mesh contact with the bowel. This modified stoppa approach affords excellent visualization of the pelvic ring, facilitating the development and utilization of. The plate was always placed at the inner surface of pelvic ring through the stoppa approach, then, the surrounding tissues. We have used gprvs for inguinal hernia repair since 1983. The rives stoppa technique for ventral hernia repair is commonly utilized due to wellproven outcomes with low overall morbidity. The extrapelvic ilioinguinal il has been the workhorse for the anterior approach and remains the gold standard. A total of 17 polytrauma patients with pelvic andor acetabular fractures were consecutively treated using the modified stoppa approach. Pararectus approach parallel or even exceed those achieved by the use of the modified stoppa approach in acetabular fracture surgery.
In 1994, cole and bolhofner described the modified stoppa approach, through intrapelvic dissection from the midline, and that the additional lateral window iliac window in the ilioinguinal approach can make the. The stoppa approach versus the ilioinguinal approach for. Atlas of advanced operative surgery 1st edition pdf. The stoppa approach for acetabular fracture springerlink. Modified stoppa approach for surgical treatment of acetabular. Data from all acetabular fractures n 96 treated surgically were collected between january 2012 and june 2015. According to the exclusion criteria, 22 patients who had undergone a single suprailioinguinal approach with a minimum of 1year followup were included in the study. Methodsthe ganz pao was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified stoppa approach through the. Modified stoppa approach for surgical treatment of. The pararectus approach combines the advantages of the ilioinguinal approach and the stoppa approach. The modified stoppa approach for reduction of fracture acetabulum improves access to quadrilateral surface and posterior column and is considered to be advantageous in many facets of the surgery.
As 1 increases, the mode moves to the right producing a thicker tail. In 1994, cole and bolhofner began to use it successfully as minimally invasive acetabulum surgery in adult patients. The modified stoppa approach is considered an alternate to anterior approach. Pfannenstiel incision approximately 10 cm for modified stoppa approach. Pdf modified stoppa approach in acetabular fractures. Pdf the stoppa approach for acetabular fracture researchgate. Stoppa approach, an alternative for total hip arthroplasty. Stoppa approach has been used for treatment of inguinal stoppa approach has been used for treatment of inguinal hernias. The intrapelvic approach, also called the modified stoppa approach46, was introduced as a less invasive alternative to the extrapelvic ilioinguinal approach, mostly combined with the first window of the ilioinguinal.
Properitoneal or stoppa procedure functionally replace the transversalis fascia the prosthesis adhere to the peritoneum and render it inextensible so it cannot protrude mersilene is preferable repair of the wall defect is unnecessary can be performed unilaterally or bilaterally use transverse or ant groin incision for unilateral approach. Through comparing the efficacy and safety of ilioinguinal approach and stoppa approach in the treatment of displaced acetabular fracture, statistical significance was found in the average operation time wmd 68. A valuable alternative to the standard approaches for acetabular surgery. I distribution is commonly known as the power distribution, described later in section 33. It was dissected in all the cadavers to simulate real surgery. We believe that the stoppa approach with an iliac window extension, previously described as a modified stoppa approach is adequate for the majority of acetabular fractures excluding those with predominant posterior wall involvement. The stoppa approach for treatment of acetabular fractures. We present a study with our experience and learning curve for this technique. This new resource picks up where other surgical references leave off, providing highly visual, stepbystep guidance on more than 100 advanced and complex procedures in both general and subspecialty areas.
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