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. The stoppa procedure is a tensionfree type of hernia repair. 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. Acetabular fracture fixation via a modified stoppa limited i. Single modified ilioinguinal approach for the treatment of. However, this approach is limited by the amount of myofascial advancement and sublay space available for a wide mesh overlap. Founded in the late 19th century by a wealthy lawyer named gianmarco ageno, the estate is currently run by elena pantaleoni and head vignaiolo giulio armani.
Though it is primarily an approach to the anterior column a useful though less effective approach. Posterior component separationtransversus abdominis release. Recent studies have reported fewer complications and less morbidity from the stoppa approach 17, 18. The modified stoppa approach is an intrapelvic approach initially used for inguinal hernia surgery by rives et al. 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. 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. The modified stoppa approach for acetabular fracture. Newly modified stoppa approach for acetabular fractures. Pdf we analyzed the extent of the comminution in the acetabular. The midline approach for hernia treatment with a complicated incision was first described by stoppa in 1989. The stoppa approach in its modified form is an intrapelvine approach for the treatment of acetabular fractures.
Stoppa approach for intrapelvic damage control and reconstruction. Minimally invasive treatment of bothcolumn acetabular. On the contrary, stoppa approach belongs to the intrapelvic ones. The extrapelvic ilioinguinal il has been the workhorse for the anterior approach and. Fracture acetabulum is a challenging, difficult to treat orthopedic injury due to its location and associated concomitant injuries. Methodsthe ganz pao was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified stoppa approach through the.
A randomized controlled clinical study was conducted to provide an. Suprailioinguinal versus modified stoppa approach in the. Stoppa approach, an alternative for total hip arthroplasty in an intrapelvic cup. The pararectus approach combines the advantages of the ilioinguinal approach and the stoppa approach. The primary modification of the primitive stoppa approach was the dissection performed laterally and posteriorly into the internal iliac fossa and the quadrilateral surface. The entire internal iliac fossa as well as the pelvic brim are exposed. Fixation of pelvicacetabular fractures using a midline. Advance your surgical expertise with atlas of advanced operative surgery. The stoppa approach versus the ilioinguinal approach for. Injury of the obturator nerve in the modified stoppa.
Stoppa approach has been used for treatment of inguinal stoppa approach has been used for treatment of inguinal hernias. Clinicoradiological outcomes of using modified stoppa. Modified stoppa approach for fractures of the acetabulum. Compared to the modified stoppa approach, the suprailioinguinal approach provides a closer visualization to the. Clinicoradiological outcomes of using modified stoppa approach. 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.
Pdf modified stoppa approach for surgical treatment of. Stoppa procedure in bilateral inguinal hernia springerlink. Modified stoppa as an alternative surgical approach for. This modified stoppa approach affords excellent visualization of the pelvic ring, facilitating the development and utilization of. A modified stoppa technique approach for treatment of. 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. Hence, the modified stoppa approach msa can be adopted by a. Suprailioinguinal versus modified stoppa approach in the treatment. 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. 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.
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. Acetabular fractures are complex intraarticular fractures. 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. Atlas of advanced operative surgery 1st edition pdf. Modified stoppa approach for surgical treatment of. A valuable alternative to the standard approaches for acetabular surgery.
We have used gprvs for inguinal hernia repair since 1983. Most surgeons performing abdominalwall surgery consider the rives stoppa technique to be the gold standard procedure in the open treatment of. Goals are the gentle softtissue preparation, anatomic reduction and stable internal fixation. Modified rivesstoppa technique for repair of complex. In 1994, cole and bolhofner began to use it successfully as minimally invasive acetabulum surgery in adult patients. Safety of modified stoppa approach for ganz periacetabular. 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. However, there is no clinical evidence to confirm its efficiency. The modified stoppa approach was introduced to manage fracture of the anterior column instead of the ilioinguinal approach to reduce morbidity. Clinical results of acetabular fracture management with the. 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.
Modified stoppa approach for surgical treatment of acetabular. Ilioinguinal approach versus stoppa approach for open reduction. 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. I distribution, defined by adding the shape parameter. This video describes a step by step approach to perform the reduction and fixation of acetabular fractures from the front. 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. Thus, anterior component separation was developed to allow further myofascial advancement. It has many advantages, particularly in cases of recurrent or multirecurrent inguinal hernias. We used a consecutive group of 29 adult patients with acetabular fractures treated operatively with a newly modified stoppa approach. Treatment results for acetabulum fractures using the modified stoppa approach. 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.
Pdf modified stoppa approach in acetabular fractures. The plate was always placed at the inner surface of pelvic ring through the stoppa approach, then, the surrounding tissues. Cole and bolhofner described a modified stoppa approach through the rectus abdominus muscle for the treatment of fractures of the pelvic ring or acetabulum. The modified stoppa approach is considered an alternate to anterior approach. This approach, described by hirvensalo 26 and later cole 27, is a modification of the intrapelvic approach described by stoppa et al. 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 ilioinguinal approach versus the anterior intrapelvic. The newly modified stoppa approach was performed to fix the acetabular fractures with main anterior displacement and the anterior and lateral. Displaced acetabular fractures are intraarticular fractures of the weightbearing joints, and best treated through open reduction and internal fixation. 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. Stoppa r, petit j, abourachid h, henry x, duclaye c, monchaux g, et al.
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. The uadrilateral surface is also visualized through this approach. A consecutive cohort of 60 patients from september 2014 to october 2017 with displaced acetabular fractures involving the quadrilateral plate were treated. Therefore, minimally invasive surgery is more appropriate. Stoppa approach, an alternative for total hip arthroplasty. A total of 17 polytrauma patients with pelvic andor acetabular fractures were consecutively treated using the modified stoppa approach. Introduction acetabular fractures are complex intraarticular fractures. The stoppa approach allows for pelvic damage control and reconstruction of bone defect. Acetabular fractures pose a great surgical challenge for orthopedic trauma surgeons. Our approach to the rivesstoppa technique springerlink. The rives stoppa technique for ventral hernia repair is commonly utilized due to wellproven outcomes with low overall morbidity. Modified stoppa approach for fractures of the acetabulum cyril mauffrey, md on vimeo. 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. The stoppa approach for acetabular fracture springerlink.
We present a study with our experience and learning curve for this technique. Pfannenstiel incision approximately 10 cm for modified stoppa approach. Pdf treatment results for acetabulum fractures using the. 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. The extrapelvic ilioinguinal il has been the workhorse for the anterior approach and remains the gold standard. It was dissected in all the cadavers to simulate real surgery.
Pdf the stoppa approach for acetabular fracture researchgate. I distribution is commonly known as the power distribution, described later in section 33. Given the specificity of reduction and fixation process, each approach bears different advantages and disadvantages in treating displaced. Data from all acetabular fractures n 96 treated surgically were collected between january 2012 and june 2015. Ii distribution is one of three generalisations of the pareto. The stoppa approach can be applied successfully in anterior acetabulum and selected posterior surgery and satisfactory results can be obtained. However, as both classical and type ii pareto distribu. Modified stoppa approach by cyril mauffrey duration. The stoppa approach in hip revision surgery can be a complement to traditional approaches to control the. Pararectus approach parallel or even exceed those achieved by the use of the modified stoppa approach in acetabular fracture surgery. In this paper we will present our experience in using the stoppa approach.
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