The modified stoppa, or anterior intrapelvic, approach to the acetabulum provides straightforward anatomic exposure that can be used for direct access to the pelvic brim, posterior column of the acetabulum, and the quadrilateral surface. According to regulation eu no 6192011, trace amounts of nonauthorised genetically modified organisms gmo in feed are tolerated within the eu if certain. Then, the pelvic ring was exposed subperiosteally from the pubic symphysis to the anterior aspect of the sacroiliac joint. Our results highlight the difficulty but feasibility in treating posterior column displacement through an anterior approach. Safety of modified stoppa approach for ganz periacetabular. The third hospital of gansu province, lanzhou, china. Acetabular fracture fixation via a modified stoppa limited i. Compared to the ilioinguinal approach, it is less invasive and does not require dissection of the inguinal canal, femoral vessels or femoral nerve. However, compared with the ilioinguinal approach, the modified stoppa approach reduced intraoperative blood lossand in doing so decreased wound drainage and the need for blood transfusionand. Oct 01, 20 it is well known that the ilioinguinal approach is time consuming 10 and likely to cause blood loss. Open surgical management of unstable pelvic ring injuries has been discussed controversially compared to percutaneous techniques in terms of surgical site morbidity especially in older patients. In this study, the functional results and complications were compared of the modified stoppa approach and ilioinguinal approach both of which are used successfully in acetabular fractures.
This study demonstrates that the modified ilioinguinal approach is a simple and. This video described the surgical technique and our 11 steps to perform a modified stoppa approach. Modified stoppa approach for fractures of the acetabulum cyril mauffrey, md on vimeo. Bastian et al compared the modified stoppa approach with the pararectus approach for for patients with acetabular fractures involving the anterior column. The evolution of the retromuscular repair duration. Modified stoppa approach for acetabular fractures with. They have exquisite structures and similar designs. Introduction acetabular fractures are complex intraarticular fractures. The modified stoppa approach to the anterior pelvis was used in 22 cases. Acetabulum fractures archives trauma international.
Jan 14, 2014 a total of 94% of the fractures united. The full text of this article is available in pdf format. Read the stoppa approach versus the ilioinguinal approach for anterior acetabular fractures. Treatment using the modified stoppa approach was suitable for anterior. 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. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. The stoppa repair is a tension free type of hernia repair.
The stoppa approach is used in the repair of inguinal hernias. Md jaaos journal of the american academy of orthopaedic surgeons. Surgical treatment of displaced acetabular fractures using. Modified stoppa approach by cyril mauffrey youtube. The patients were operated on by 3 surgeons 1 professor and 2 attending surgeons and surgery. Omar al bardan only the paranoid survive 8,967 views. Additionally, with the aip approach, the socalled middle window of the ilioinguinal approach can frequently be avoided, resulting in minimal dissection of the inguinal canal, femoral nerve, and external iliac vessels. The modified stoppa approach is considered an alternate to anterior approach, which provides access to pelvis from inside the cavity. Modified stoppa approach for acetabular fractures with anter. Modified stoppa approach for fractures of the acetabulum. The stoppa approach for acetabular fracture springerlink. The stoppa approach versus the ilioinguinal approach for. 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 extrapelvic ilioinguinal il has been the workhorse for the anterior approach and remains the gold standard.
Complications are represented by thrombosis after iliac vessels stretching and bladder. Modified stoppa, ilioinguinal, acetabulum fractures. Maximum protection of the facial nerve requires welldesigned surgical te d dissection. All participants in the study provided written the free and informed. This modified stoppa approach affords excellent visualization of the pelvic ring, facilitating the development and utilization of. In the case presented herein, a modified stoppa technique approach with anterior column fracture fixation was used. May 17, 20 cole and bolhofner described a modified stoppa approach through the rectus abdominus muscle for the treatment of fractures of the pelvic ring or acetabulum. They will lead us on site, take the measures, and provide us with the best solutions to create and furnish your business premises. Modified stoppa approach for surgical treatment of. May 27, 20 in the case presented herein, a modified stoppa technique approach with anterior column fracture fixation was used. Surgical treatment of displaced acetabular fractures using a.
Surgical outcomes of acute acetabular transverse fracture. Using this modified surgical technique, we can maximally prevent facial nerve injury. A modified stoppa technique approach for treatment of. Modified stoppa approach for fractures of the acetabulum vumedi. Three cadaveric studies810 and two case reports11,12 were excluded. In this paper we will present our experience in using the stoppa approach, its. A minimally invasive technique using a modified stoppa. Learn about the acetabulum stoppa approach, an online 3dvideobased course, accredited by the royal college of surgeons of england. This video describes a step by step approach to perform the reduction and fixation of acetabular fractures from the front. The midline approach for hernia treatment with a complicated incision was first described by stoppa in 1989. The transverse stoppa incision was made 2 cm over the symphysis pubis for quadrilateral surface exposure and pubic and ischial bone osteotomies.
Ota video library modified stoppa approach for fractures of. The stoppa procedure led to improvement in the laparoscopic tep approach to preperitoneal placement tension free mesh hernia repair in the early 1990s, because the procedure itself could now be exactly mimicked by laparoscopic means, and the mesh could be inserted in exactly the same plane for reinforcing the inguinal region, as described by. This video described the surgical technique and our 11 steps to perform a modified stoppa. 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. Nevertheless, outcomes of this operative approach have yet to be reported or evaluated in this locality. Department of orthopaedics, gansu provincial hospital of tcm, lanzhou, china. Clinicoradiological outcomes of using modified stoppa. Conversion to stoppa procedure in laparoscopic totally.
Surgical approach to acetabulum may be anterior ilioinguinal, iliofemoral, stoppa approach 1,2, posterior kocherlangenbeck approach and variants 3 or combined simultaneous or different sittings 4. Sep 14, 2012 acetabular fractures pose a great surgical challenge for orthopedic trauma surgeons. Nineteen patients were treated with the ilioinguinal approach fig. In 1994, cole and bolhofner began to use it successfully as minimally invasive acetabulum surgery in adult patients. All of the osteotomies were performed under fluoroscopic control and direct. Pdf modified stoppa approach for surgical treatment of.
The modified stoppa approach for acetabular fracture archdeacon, michael t. Atlas of advanced operative surgery 1st edition pdf free. It is well known that the ilioinguinal approach is time consuming 10 and likely to cause blood loss. An answer is being sought to the debate as to whether the complication rate and amount of blood loss is minimal if the modified stoppa is considered to be. Pdf the modified stoppa approach for acetabular fracture.
Internal fixation of unstable pelvic ring injuries via the modified stoppa approach 31 connecting vessel between the obturator and femoral artery, was identified and ligated. The aim of this cadaveric study was to investigate the efficacy of the modified stoppa approach in ganz periacetabular osteotomy pao. The stoppa procedure led to improvement in the laparoscopic tep approach to preperitoneal placement tensionfree mesh hernia repair in the early 1990s, because the procedure itself could now be exactly mimicked by laparoscopic means, and the mesh could be inserted in exactly the same plane for reinforcing the inguinal region, as described by. Atlas of advanced operative surgery 1st edition pdf. 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. Modified ilioinguinal approach to treat pelvic or acetabular. The choice of approach depends on the type of fracture, displacement and the surgeons preference 5. More specifically, the operation was performed in cases with free.
Pdf we analyzed the extent of the comminution in the acetabular weightbearing area. Hirvensalo et al and cole and bolhofner described a modified stoppa approach involving an. 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. Journal of orthopaedic surgery and research articles.
Modified rivesstoppa repair for abdominal incisional hernias. It can be concluded that the modified stoppa approach could be used as an alternative to the. The improved visualization provided by this approach facilitates fracture reduction and stabilization. Society of american gastrointestinal and endoscopic surgeons sages. Acetabular fractures pose a great surgical challenge for orthopedic trauma surgeons. The modified stoppa approach was first described by cole and bolhofner 1 in 1994.
Case report a modified stoppa technique approach for. The modified stoppa approach is an intrapelvic approach initially used for inguinal hernia surgery by rives et al. This operation is also known as giant prosthetic reinforcement of the visceral sac gprvs. 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. The modified stoppa ie, aip approach provides improved exposure of the quadrilateral surface and posterior column. Pdf modified stoppa approach in acetabular fractures. However, the modified stoppa approach needs much more delicate dissection in the cases with intrapelvic adhesions such as revision surgery including implant removal, and previous surgery in the lower abdomen. It can be concluded that the modified stoppa approach could be used as an alternative. Arthroscopic shavers play an indispensable role in arthroscopic debridement. The stoppa approach versus the ilioinguinal approach for anterior. Modified stoppa approach for acetabular fractures with anterior and posterior column displacement. The stoppa repair is a tensionfree type of hernia repair. Newly modified stoppa approach for acetabular fractures.
Modified stoppa approach for acetabular fractures with anterior and posterior. Mar 31, 2016 the modified stoppa approach was first described by cole and bolhofner 1 in 1994. A statistical approach to quantification of genetically modified organisms gmo using frequency distributions lars gerdes, ulrich busch and sven pecoraro abstract background. Thus, we assessed the impact of age on the outcome following fixation of unstable pelvic ring injuries through the modified stoppa approach. Pdf the stoppa approach for acetabular fracture researchgate. 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. Stoppa approach to acetabulum approaches orthobullets. The ganz pao was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified stoppa approach through the pfannenstiel incision. Minimally invasive treatment of bothcolumn acetabular. Ota video library modified stoppa approach for fractures of the acetabulum cyril mauffrey, md on vimeo. Treatment of acetabulum fractures through the modified stoppa. A total of 17 polytrauma patients with pelvic andor acetabular fractures were consecutively treated using the modified stoppa approach.
Kocherlangenbeck approach to the acetabulum posterior approach 04. Society of american gastrointestinal and endoscopic surgeons sages 12,292 views 11. The modified stoppa approach for acetabular fracture. A consecutive cohort of 17 patients with displaced acetabular fractures treated operatively with use of only an anterior approach that combined the modified stoppa approach with the lateral window of the ilioinguinal approach.
Compared to the other pelvic approaches, it is much easier to perform the modified stoppa approach in patients with a thin body type. Modified stoppa approach for surgical treatment of acetabular. A modified stoppa technique approach for treatment of pediatric acetabular fractures mehmetelmadag 1 andmehmetaliacar 2 department of orthopedics and traumatology, medical faculty, bezmialem vakif university, fatih, istanbul, turkey department of orthopedics and traumatology, selcuklu medicine faculty, selcuk university, konya, turkey. From october 2010 to may 2014, 18 patients with pelvicacetabular fractures were fixed using modified stoppa approach. Stoppa design and technology have been happily working for years with professionals and craftmens who deeply know our work method, so that each project develolpment flows. Fixation of pelvicacetabular fractures using a midline. They found that the latter facilitated surgical access in the false pelvis, provided versatility for fracture fixation in the posterior pelvic ring, and afforded the surgeon the option to. Advance your surgical expertise with atlas of advanced operative surgery. Randomized, controlled trial of the modified stoppa versus. This study evaluates applicability of the modified stoppa approach in the performance of bernese periacetabular osteotomy pao. The modified stoppa approach in the treatment of a t shaped acetabular fracture surgical video tech duration. Cole and bolhofner described a modified stoppa approach through the rectus abdominus muscle for the treatment of fractures of the pelvic ring or acetabulum. Oct 01, 2014 read the stoppa approach versus the ilioinguinal approach for anterior acetabular fractures.
Twenty five patients who managed with ilioinguinal approach group a at a mean followup of 32. Pdf we analyzed the extent of the comminution in the acetabular weight bearing area. Figure 5 from the modified stoppa approach for acetabular. The newly modified stoppa approach was performed to fix the acetabular fractures with main anterior displacement and the anterior and lateral parts of the pelvis. The modified stoppa approach provides direct visualization of the entire pelvic brim from the pubic symphysis to the anterior aspect of the sacroiliac joint. The modified stoppa incision, which provides more comfortable access to the pelvic brim and quadrilateral surface, has been previously introduced for acetabular fracture treatment. Internal fixation of unstable pelvic ring injuries via the. Indications and contraindications general agreement exists for the use of the modified stoppa approach for all fractures that can be managed. In agreement with prior published data, our results show good functional outcomes with minimal complications using the modified stoppa approach for a variety of acetabular fractures. The purpose of this study was to establish a reproducible testing protocol to co.
551 350 131 1659 1403 1283 897 898 809 1211 1273 1087 1099 1643 239 1123 821 603 1229 187 234 277 402 1032 1472 799 797 260 508 455 1373 553 48 1128 9