The intrapelvic approach to the acetabulum

Abstract

The today well accepted intrapelvic approach for acetabular and pelvic ring injury fixation was first described by Hirvensalo and Lindahl in 1993 followed by a more detailed description by Cole and Bolhofner in 1994. Compared to the well-known ilioinguinal approach, described by Letournel, this approach allows an intrapelvic view to the medial acetabulum, while using the ilioinguinal approach a more superior, extrapelvic view, is dissected to the area of the acetabulum. Several names have been used to describe the new intrapelvic approach with increasing usage, mainly ilio-anterior approach, extended Pfannenstiel approach, Stoppa-approach, Rives-Stoppa approach, modified Stoppa approach and recently anterior intrapelvic approach. Especially names including "Stoppa", based on the French surgeon Rene Stoppa, an inguinal hernia surgeon, have been discussed. In contrast to the presently used intrapelvic approach, the original the Rives-Stoppa approach refers to a sublay-retromuscular technique, which places a mesh posterior to the rectus muscle and anterior to the posterior rectus sheath without dissecting along the upper pubic ramus. Thus, intrapelvic approach is not a Rives-Stoppa approach. The Cheatle-Henry approach, another inguinal hernia approach, refers best to the presently used intrapelvic approach. Discussing the anatomy and the different dissections, this approach allows anteromedial access to the anterior column and a direct view from inside the true pelvis to the quadrilateral plate and medial side of the posterior column. Thus, we favor to use the term "Intrapelvic Approach".

Keywords: Extended intrapelvic approach; Intrapelvic approach; Results; Stoppa´s hernia repair.

Fig. 1

Drawing from Henry showing the access to the superior ramus [19]

Fig. 2

Schematic concept of the Rives-Stoppa retromuscular approach