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Abstract Objective To describe the clinical and radiographic outcomes of a cohort of patients with acetabular fractures treated with the modified Stoppa approach. Methods We conducted a prospective analysis of adult patients with acetabular fractures treated using the modified Stoppa approach from June 2020 to June 2021, with a minimum follow-up period of 12 months. The analysis included demographic, epidemiological, and perioperative data, as well as postoperative radiographic and functional outcomes. Results The study included 15 cases, with 14 men (93.3%) and 1 woman (6.67%). A postoperative tomographic evaluation revealed an anatomical reduction in 50%, an imperfect reduction in 13.6%, and a poor reduction in 36.4% of the subjects. Regarding the functional scores, the Harris Hip Score ranged from 56 to 100, with a mean value of 92.5. The Majeed Pelvic Score classified the functional outcome as excellent in 36.5%, good in 40.6%, moderate in 18.7%, and poor in 4.2% of the cases. Conclusion The present case series study demonstrated positive statistical relevance between reduction quality and functional outcomes and between the time until surgery and the reduction quality. The functional outcomes at a one-year of follow-up demonstrate that this approach can be an excellent alternative for anterior acetabulum fractures.

Resumo Objetivo Descrever os resultados clínicos e radiográficos de uma coorte de pacientes com fraturas de acetábulo tratados com o acesso de Stoppa modificado. Métodos Foi realizada uma análise prospectiva de pacientes adultos com fraturas de acetábulo tratados pela via de Stoppa modificada de junho de 2020 a junho de 2021 e com seguimento mínimo de 12 meses. Foram analisados dados demográficos, epidemiológicos e perioperatórios, e resultados radiográficos e funcionais pós-operatórios. Resultados Foram estudados 15 casos, sendo 14 homens (93,3%) e 1 mulher (6,67%). Na avaliação tomográfica pós-operatória, redução anatômica foi observada em 50% dos casos, imperfeita, em 13,6%, e ruim, em 36,4%. Nos escores funcionais, encontramos uma variação de 56 a 100, com média de 92,5 no Harris Hip Score. No Majeed Pelvic Score, o resultado funcional foi excelente em 36,5% dos casos, bom, em 40,6%, moderado, em 18,7%, e ruim, em 4,2%. Conclusão O estudo da série de casos demonstrou relevância estatística positiva entre a qualidade da redução e os desfechos funcionais, assim como entre o tempo até a cirurgia e a qualidade da redução. Os resultados funcionais no seguimento de um ano demonstram que o uso dessa via pode ser uma excelente alternativa para as fraturas anteriores do acetábulo.

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Objective To describe the clinical and radiographic outcomes of a cohort of patients with acetabular fractures treated with the modified Stoppa approach. Methods We conducted a prospective analysis of adult patients with acetabular fractures treated using the modified Stoppa approach from June 2020 to June 2021, with a minimum follow-up period of 12 months. The analysis included demographic, epidemiological, and perioperative data, as well as postoperative radiographic and functional outcomes. Results The study included 15 cases, with 14 men (93.3%) and 1 woman (6.67%). A postoperative tomographic evaluation revealed an anatomical reduction in 50%, an imperfect reduction in 13.6%, and a poor reduction in 36.4% of the subjects. Regarding the functional scores, the Harris Hip Score ranged from 56 to 100, with a mean value of 92.5. The Majeed Pelvic Score classified the functional outcome as excellent in 36.5%, good in 40.6%, moderate in 18.7%, and poor in 4.2% of the cases. Conclusion The present case series study demonstrated positive statistical relevance between reduction quality and functional outcomes and between the time until surgery and the reduction quality. The functional outcomes at a one-year of follow-up demonstrate that this approach can be an excellent alternative for anterior acetabulum fractures.

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BACKGROUND: This article aims to share the initial experience of the preperitoneal eTEP approach and its potential benefits in a selected group of patients. The eTEP Rives-Stoppa is a proven minimally invasive surgical technique for the treatment of ventral midline and off-midline hernias that has shown to be a solid, durable, and reproducible repair. The preperitoneal eTEP repair is a surgical technique that brings together the extraperitoneal access surgery with a preperitoneal repair for primary midline hernias avoiding posterior rectus sheath division and preservation of the retrorectus space while being able to treat simultaneous diastasis recti. METHODS: The analysis included 33 patients operated with the preperitoneal eTEP approach from September 2022 to September 2023 in patients with primary small to medium (< 4 cm) midline hernias, single or multiple defects with or without diastasis recti. Age, gender, hernia characteristics, operative time, and surgical site occurrences will be discussed, as well as fine details and landmarks in the operative technique. RESULTS: 33 consecutive patients were operated, 19 female (57.5%) and 14 males (42.5%) between 32 and 63 years of age, the most common comorbidity found was obesity (BMI > 30). In 70% of the cases, operative time was 90 min ± 25 min. The average hospital stay was one day, while 12 went home the same day, and so far, no reoccurrences have been reported. CONCLUSIONS: We believe the preperitoneal eTEP approach for small to medium primary midline hernias is an effective and solid repair that combines excellent features of proven surgical techniques and eliminates the need for posterior rectus sheath division while saving the retrorectus space, among other benefits that will be discussed. The reproducibility of the technique remains to be proven.

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BACKGROUND: The eTEP Rives-Stoppa (RS) procedure, increasingly used for ventral hernia repair, has raised concerns about postoperative upper abdominal bulging. This study aims to objectively evaluate changes in the abdominal contour after eTEP RS and explore potential causes using a novel analytical tool, the Ellipse 9. METHODS: Thirty patients undergoing eTEP RS without posterior rectus sheath closure were assessed before and 3 months after surgery using CT scan images. Key measurements analyzed included the distance between linea semilunaris (X2), eccentricity over the Cord (c/a Cord), superior eccentricity (c/a Sup), Y2, and the superior perimeter of the abdomen. The Ellipse 9 tool, which provides graphical images and numerical representations, was utilized alongside patient-reported outcomes to assess perceived abdominal changes. RESULTS: The study group exhibited a trend toward a flatter abdomen with reduced distance between linea semilunaris(X2). However, 17% of patients developed upper abdominal bulging (5). Significant differences in c/a Cord, c/a Sup, Y2, and the superior perimeter of the abdomen, confirmed with Bonferroni corrections, were noted between bulging (5 patients) and non-bulging groups (25 patients). There was a notable disparity between patient perceptions and objective outcomes. CONCLUSION: The eTEP RS procedure improved abdominal contour in most patients from a selected cohort. The Ellipse 9 tool was valuable for the objective analysis of these changes. The cause of bulging post-eTEP RS is probably multifactorial. Notably, there was often a discrepancy between patient perceptions of bulging and objective clinical findings.

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Introduction: Developmental dysplasia of the hip (DDH) is the cause of 2.6-9.1% of all total hip prostheses implanted at any age and constitutes a challenge in revision surgeries. Objective: To present a case of severe acetabular dysplasia managed by the Stoppa-type approach. The Case: We report a case of a 26-year-old male patient with DDH initially treated with total hip replacement and then diagnosed with aseptic loosening (Paprosky 3A). Using a modified Stoppa approach; acetabular augmentation and bone autograft attached with endopelvic reconstruction plates were performed. Two years after the procedure our patient is asymptomatic, has no restrictions on his daily living activities, and is very satisfied with the result. Conclusions: The Stoppa approach was very useful for the endopelvic reconstruction of the acetabular roof, so it may be an option to treat severe acetabular defects. Level of evidence: IV.

Introducción: La displasia del desarrollo de cadera (DDH, por sus siglas en inglés) es la causa del 2,6-9,1 % del total de prótesis de cadera implantadas a cualquier edad y constituye un reto en las cirugías de revisión. Objetivo: Presentar un caso de displasia acetabular grave manejado por abordaje tipo Stoppa. El caso: Presentamos un caso de un paciente masculino de 26 años con DDH tratado inicialmente con reemplazo total de cadera y luego diagnosticado con aflojamiento aséptico (Paprosky 3A). Se utilizó un enfoque Stoppa modificado. Se realizó aumento acetabular y autoinjerto óseo unido con placas de reconstrucción endopélvica. Dos años después del procedimiento, el paciente es asintomático, no tiene restricciones en sus actividades de la vida diaria y está muy satisfecho con el resultado. Conclusiones: El abordaje de Stoppa fue muy útil para la reconstrucción endopélvica del techo acetabular, por lo que puede ser una opción para tratar defectos acetabulares graves. Grado de comprobación: IV.

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RESUMEN Antecedentes: La cirugía laparoscópica presenta ventajas que son claramente observadas en la reparación de hernias bilaterales y recidivadas. El uso de una malla única como alternativa en la reparación de las inguinales bilaterales laparoscópicas con técnica transabdominal (TAPP) puede reducir el índice de recidivas y las chances de dolor crónico. Objetivo: describir y analizar los beneficios del uso de una malla única en el tratamiento de las hernias inguinales bilaterales con técnica TAPP. Material y métodos: análisis retrospectivo de hernioplastias inguinales laparoscópicas directas o mixtas operadas por vía transabdominal con malla única, efectuadas en pacientes con hernias inguinales bilaterales. Resultados: entre enero de 2016 y enero de 2017 se operaron 177 pacientes con hernia inguinal. Noventa y tres (93) pacientes presentaron hernias bilaterales, de las cuales 39 fueron operadas mediante el uso de la técnica con malla única, incluidas en este estudio. Conclusión: la utilización de una malla única es una alternativa segura en el tratamiento de las hernias inguinales bilaterales directas o mixtas operadas por vía laparoscópica con técnica TAPP.

ABSTRACT Background: The laparoscopic approach has clear advantages for repairing bilateral hernias and recurrent hernias. The use of a single mesh as an option in the laparoscopic treatment of direct bilateral inguinal hernias with the transabdominal preperitoneal (TAPP) technique, may reduce the recurrence rate and chronic pain. Objective: The aim of this study is to analyze the benefits of single mesh for the treatment of bilateral inguinal hernias with the TAPP technique. Material and methods: We conducted a retrospective analysis of patients with bilateral direct inguinal hernias undergoing laparoscopic hernia repair with the TAPP technique using a single mesh. Results: Between January 2016 and January 207 177 patients underwent inguinal hernia repair. Of the 93 patients with bilateral hernias, a single mesh was used in 39, which were included in this study. Conclusion: The use of a single mesh is a safe option for the laparoscopic treatment of direct bilateral inguinal hernias with the TAPP technique.

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INTRODUCTION: Multiple minimally invasive techniques have been described for ventral hernia repair. The recently described enhanced view totally extraperitoneal (eTEP) ventral hernia repair seems an appealing option since it allows to address midline and lateral hernias, placing the mesh in the retromuscular position without the use of traumatic fixation. AIM: To report on the mid-term result of a series of patients with ventral hernias repaired by the eTEP approach. METHODS: A retrospective analysis of our case series between June 2017 and December 2019. Demographic and clinical data were gathered. Hernia characteristics, surgical details, hernia recurrences, and complications are reported. RESULTS: 66 patients were included in the study. Median follow-up was 22 months (interquartile range 12-26). 60% of patients were male. Mean age, BMI, % of Type-2 diabetes and % of smoking were 59 ± 12 years, 30 kg/m2, 24% and 23%, respectively. Mean hernia defect size was 5.5 ± 2.9 cm. Forty-three eTEP Rives-stoppa and 23 eTEP-Transversus abdominis release (14 unilateral, 9 bilateral) were performed. 22 inguinal hernias and 15 lateral defects were simultaneously repaired. We report 1 recurrence (1.5%) and 10 surgical site occurrences (15%; 6 seromas, 2 hematomas and 2 surgical site infections). Four patients required reinterventions (6%). CONCLUSION: eTEP is a promising approach to treat midline hernias and allows the simultaneous treatment of lateral and inguinal defects, keeping the mesh in the retromuscular position. However, comparative studies must be performed to know its real benefit in laparoscopic ventral hernia repair.

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Resumen: Introducción: Las fracturas de acetábulo complejas son un desafío para los cirujanos ortopedistas. Se realizó una evaluación de la reducción radiográfica y resultado funcional de los pacientes con fractura compleja de acetábulo sometidos a abordaje combinado Kocher-Langenbeck y Stoppa. Material y métodos: Diseño transversal, descriptivo, ambispectivo. Se incluyeron pacientes con fractura compleja de acetábulo que se sometieron a abordaje combinado Kocher-Langenbeck y Stoppa entre 2016 y 2020. Se revisaron los expedientes clínicos y se evaluó la calidad de la reducción radiográfica según criterios de Matta. Además, se realizó evaluación funcional con la escala de Merle d'Aubigné y Postel pasados por lo menos 12 meses de la lesión. Resultados: De los 31 pacientes, el tiempo promedio entre la fecha de fractura y la intervención quirúrgica fue de 13.7 días (de tres a 38 días). En la evaluación radiográfica según criterios de Matta, 21 pacientes tuvieron resultados radiográficos anatómicos (67.7%), siete casi anatómicos (22.5%) y tres imperfectos (9.6%). Los resultados funcionales según la escala Merle d'Aubigné y Postel dieron como resultado ocho pacientes (25.8%) con resultados excelentes, 16 (51.6%) con resultado bueno, con resultado moderado cinco (22.5%) y con resultado malo dos (16.1%). Hubo correlación estadística entre la edad del paciente con el resultado funcional (p = 0.029), también entre el índice de masa corporal y pérdida sanguínea (p = 0.027). Conclusión: Los abordajes combinados Kocher-Langenbeck y Stoppa son una alternativa en estas lesiones, en su mayoría con resultados radiográficos anatómicos y casi anatómicos, según la escala radiográfica de Matta, y con excelentes y buenos resultados funcionales, según la escala de Merle d'Aubigné y Postel.

Abstract: Introduction: Complex acetabulum fractures are a challenge for orthopedic surgeons. An evaluation of the radiographic reduction and functional result of the patients with complex fracture of the acetabulum who underwent the combined Kocher-Langenbeck and Stoppa approach was carried out. Material and methods: Cross-sectional, descriptive, ambispective design. Patients with complex acetabulum fracture who underwent the combined Kocher-Langenbeck approach plus Stoppa between 2016 and 2020 were included. The clinical records were reviewed, and the quality of the radiographic reduction was evaluated according to Matta criteria. In addition, a functional evaluation was performed with the Merle d'Aubigne and Postel scale at least 12 months after the injury. Results: Of the 31 patients, the average time between the date of fractures and the surgical intervention was 13.7 days (3-38 days). In the radiographic evaluation according to Matta criteria, 21 anatomical patients (67.7%), 7 almost anatomical (22.5%), 3 imperfect (9.6%). Functional results according to the Merle d'Aubigne and Postel scale resulted in 8 (25.8%) with excellent results, 16 (51.6%) with good results, 5 (22.5%) moderate and 2 (16.1%) poor patients. There was a statistical correlation between the age of the patient and the functional result (p = 0.029), also between the body mass index and blood loss (p = 0.027). Conclusion: The combined Kocher-Langenbeck plus Stoppa approaches are a valid alternative in these lesions, mostly with anatomical and almost anatomical radiographic results according to the Matta radiographic scale, and with excellent and good functional results according to the Merle d'Aubigne and Postel scale.

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INTRODUCTION: Complex acetabulum fractures are a challenge for orthopedic surgeons. An evaluation of the radiographic reduction and functional result of the patients with complex fracture of the acetabulum who underwent the combined Kocher-Langenbeck and Stoppa approach was carried out. MATERIAL AND METHODS: Cross-sectional, descriptive, ambispective design. Patients with complex acetabulum fracture who underwent the combined Kocher-Langenbeck approach plus Stoppa between 2016 and 2020 were included. The clinical records were reviewed, and the quality of the radiographic reduction was evaluated according to Matta criteria. In addition, a functional evaluation was performed with the Merle d'Aubigne and Postel scale at least 12 months after the injury. RESULTS: Of the 31 patients, the average time between the date of fractures and the surgical intervention was 13.7 days (3-38 days). In the radiographic evaluation according to Matta criteria, 21 anatomical patients (67.7%), 7 almost anatomical (22.5%), 3 imperfect (9.6%). Functional results according to the Merle d'Aubigne and Postel scale resulted in 8 (25.8%) with excellent results, 16 (51.6%) with good results, 5 (22.5%) moderate and 2 (16.1%) poor patients. There was a statistical correlation between the age of the patient and the functional result (p = 0.029), also between the body mass index and blood loss (p = 0.027). CONCLUSION: The combined Kocher-Langenbeck plus Stoppa approaches are a valid alternative in these lesions, mostly with anatomical and almost anatomical radiographic results according to the Matta radiographic scale, and with excellent and good functional results according to the Merle d'Aubigne and Postel scale.

INTRODUCCIÓN: Las fracturas de acetábulo complejas son un desafío para los cirujanos ortopedistas. Se realizó una evaluación de la reducción radiográfica y resultado funcional de los pacientes con fractura compleja de acetábulo sometidos a abordaje combinado Kocher-Langenbeck y Stoppa. MATERIAL Y MÉTODOS: Diseño transversal, descriptivo, ambispectivo. Se incluyeron pacientes con fractura compleja de acetábulo que se sometieron a abordaje combinado Kocher-Langenbeck y Stoppa entre 2016 y 2020. Se revisaron los expedientes clínicos y se evaluó la calidad de la reducción radiográfica según criterios de Matta. Además, se realizó evaluación funcional con la escala de Merle d'Aubigné y Postel pasados por lo menos 12 meses de la lesión. RESULTADOS: De los 31 pacientes, el tiempo promedio entre la fecha de fractura y la intervención quirúrgica fue de 13.7 días (de tres a 38 días). En la evaluación radiográfica según criterios de Matta, 21 pacientes tuvieron resultados radiográficos anatómicos (67.7%), siete casi anatómicos (22.5%) y tres imperfectos (9.6%). Los resultados funcionales según la escala Merle d'Aubigné y Postel dieron como resultado ocho pacientes (25.8%) con resultados excelentes, 16 (51.6%) con resultado bueno, con resultado moderado cinco (22.5%) y con resultado malo dos (16.1%). Hubo correlación estadística entre la edad del paciente con el resultado funcional (p = 0.029), también entre el índice de masa corporal y pérdida sanguínea (p = 0.027). CONCLUSIÓN: Los abordajes combinados Kocher-Langenbeck y Stoppa son una alternativa en estas lesiones, en su mayoría con resultados radiográficos anatómicos y casi anatómicos, según la escala radiográfica de Matta, y con excelentes y buenos resultados funcionales, según la escala de Merle d'Aubigné y Postel.

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OBJECTIVE: A retrospective review aims to investigate the operative methods and therapeutic effects of the modified Stoppa approach for treating pelvic and acetabular fractures. METHODS: 18 patients with acetabular fracture of the anterior column and pelvic anterior ring fracture underwent surgical treatment using the modified Stoppa approach. Some of the treatment was combined with the iliac fossa approach or rear K-L approach. Fracture reduction and postoperative function were evaluated using the Matta scoring standard and the Majeed scoring system. The Oxford Centre for Evidence-Based Medicine system was used to grade the literature review and create graded B recommendations. RESULTS: Incision length was 6-12 cm (mean, 10 cm), operative duration was 50-150 minutes (mean, 85 minutes), and intraoperative blood loss volume was 400-1,000 ml (mean, 500 ml). 18 patients were followed up for 12-36 months post-operation. In the results of X-ray films, 12 cases were anatomical reductions and the remaining cases were satisfactory reductions. According to Majeed standard, 13 patients were excellent and five patients were good. CONCLUSIONS: Treatment using the modified Stoppa approach was suitable for anterior approaches, in which pelvic and acetabular fractures were sufficiently exposed, the fracture was conveniently reduced, less complications occurred, and curative effect was satisfactory. Level of evidence III, Retrospective comparative study.

OBJETIVO: Uma revisão retrospectiva tem como objetivo investigar os métodos operatórios e efeitos terapêuticos da abordagem modificada de Stoppa para o tratamento de fraturas pélvicas e acetabulares. MÉTODOS: 18 pacientes com fratura acetabular da coluna anterior e fratura do anel anterior pélvico foram submetidos a tratamento cirúrgico utilizando a abordagem de Stoppa modificada. Parte do tratamento foi feita em conjunto com a abordagem da fossa ilíaca ou com a abordagem pelo acesso posterior de K-L. A redução da fratura e a função pós-operatória foram avaliadas pelo padrão de pontuação de Matta e o sistema de pontuação de Majeed. O sistema do Oxford Centre for Evidence-Based Medicine foi usado para classificar a revisão de literatura e criar as recomendações de grau B. RESULTADOS: O comprimento da incisão foi de 6 a 12 cm (média de 10 cm), a duração da cirurgia foi de 50 a 150 minutos (média de 85 minutos) e o volume de perda sanguínea intraoperatória foi de 400 a 1.000 ml (média de 500 ml). 18 pacientes foram acompanhados por 12-36 meses após a operação. Nos resultados dos filmes radiográficos, 12 casos foram de reduções anatômicas e os demais casos foram de reduções satisfatórias. De acordo com o padrão de Majeed, 13 pacientes foram considerados excelentes e cinco pacientes foram considerados bons. CONCLUSÕES: O tratamento que utilizou a abordagem de Stoppa modificada foi adequado para abordagens anteriores, nas quais as fraturas pélvicas e acetabulares estavam suficientemente expostas, a fratura foi convenientemente reduzida, ocorreram menos complicações e o efeito curativo foi satisfatório. Nível de evidencia III, Estudo retrospectivo comparativo.

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ABSTRACT Objective: A retrospective review aims to investigate the operative methods and therapeutic effects of the modified Stoppa approach for treating pelvic and acetabular fractures. Methods: 18 patients with acetabular fracture of the anterior column and pelvic anterior ring fracture underwent surgical treatment using the modified Stoppa approach. Some of the treatment was combined with the iliac fossa approach or rear K-L approach. Fracture reduction and postoperative function were evaluated using the Matta scoring standard and the Majeed scoring system. The Oxford Centre for Evidence-Based Medicine system was used to grade the literature review and create graded B recommendations. Results: Incision length was 6-12 cm (mean, 10 cm), operative duration was 50-150 minutes (mean, 85 minutes), and intraoperative blood loss volume was 400-1,000 ml (mean, 500 ml). 18 patients were followed up for 12-36 months post-operation. In the results of X-ray films, 12 cases were anatomical reductions and the remaining cases were satisfactory reductions. According to Majeed standard, 13 patients were excellent and five patients were good. Conclusions: Treatment using the modified Stoppa approach was suitable for anterior approaches, in which pelvic and acetabular fractures were sufficiently exposed, the fracture was conveniently reduced, less complications occurred, and curative effect was satisfactory. Level of evidence III, Retrospective comparative study.

RESUMO Objetivo: Uma revisão retrospectiva tem como objetivo investigar os métodos operatórios e efeitos terapêuticos da abordagem modificada de Stoppa para o tratamento de fraturas pélvicas e acetabulares. Métodos: 18 pacientes com fratura acetabular da coluna anterior e fratura do anel anterior pélvico foram submetidos a tratamento cirúrgico utilizando a abordagem de Stoppa modificada. Parte do tratamento foi feita em conjunto com a abordagem da fossa ilíaca ou com a abordagem pelo acesso posterior de K-L. A redução da fratura e a função pós-operatória foram avaliadas pelo padrão de pontuação de Matta e o sistema de pontuação de Majeed. O sistema do Oxford Centre for Evidence-Based Medicine foi usado para classificar a revisão de literatura e criar as recomendações de grau B. Resultados: O comprimento da incisão foi de 6 a 12 cm (média de 10 cm), a duração da cirurgia foi de 50 a 150 minutos (média de 85 minutos) e o volume de perda sanguínea intraoperatória foi de 400 a 1.000 ml (média de 500 ml). 18 pacientes foram acompanhados por 12-36 meses após a operação. Nos resultados dos filmes radiográficos, 12 casos foram de reduções anatômicas e os demais casos foram de reduções satisfatórias. De acordo com o padrão de Majeed, 13 pacientes foram considerados excelentes e cinco pacientes foram considerados bons. Conclusões: O tratamento que utilizou a abordagem de Stoppa modificada foi adequado para abordagens anteriores, nas quais as fraturas pélvicas e acetabulares estavam suficientemente expostas, a fratura foi convenientemente reduzida, ocorreram menos complicações e o efeito curativo foi satisfatório. Nível de evidencia III, Estudo retrospectivo comparativo.

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Abstract Fracture acetabulum is a grave injury and a challenge for orthopedic surgeons. Anterior and posterior approaches have been described for fixation of acetabulum fractures. The modified Stoppa approach is considered an alternate to anterior approach, which provides access to pelvis from inside the cavity. The purpose of this article is to review the available literature on use of the modified Stoppa approach in acetabulum fractures. The available data suggest that modified Stoppa approach is useful in anterior acetabulum fractures and some posterior acetabulum fractures, especially where buttressing of medial wall is required.

Resumo Fraturas acetabulares são lesões graves e desafiadoras para cirurgiões ortopédicos. As abordagens anterior e posterior foram descritas para a fixação dessas fraturas. A técnica de Stoppa modificada é considerada uma alternativa à abordagemanterior, que fornece acesso à pelve pelo interior da cavidade. O objetivo do presente artigo é revisar a literatura disponível sobre o uso da abordagem de Stoppa modificada em fraturas de acetábulo. Os dados disponíveis sugeremque a abordagemde Stoppamodificada é útil em fraturas anteriores de acetábulo e em algumas fraturas posteriores, especialmente aquelas nas quais o reforço da parede medial se faz necessário.

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Introducción: la reparación de la hernia incisional utilizando la técnica de Rives-Stoppa es una técnica, con bajos índices de recidivas (3 a 12%) y complicaciones (15%). Objetivo: Describir los resultados en la aplicación de la Técnica de Rives-Stoppa en el tratamiento de las hernias incisionales.Pacientes y método: estudio, observacional, descriptivo, retrospectivo, de corte transversal, con muestreo no probabilístico, de casos consecutivos, desde enero 2010 a diciembre 2015. Resultados: n: 38 pacientes, siendo mujeres 33 (86,8%) y varones 5 (13,2%) . La edad promedio 52,5 años ( 20 - 78 ). Las patologías de base: 33 (86,8%). Localización de hernias incisionales, 36 (94,7%) de la línea media y 2 ventrolaterales. Antecedentes quirúrgicos, el más frecuente Cesárea 13 (34,2%). Promedio tiempo quirúrgico 116,7 minutos.Tuvimos 1 (2,6%) complicación local, sangrado tejido celular. Estancia hospitalaria promedio 2,3 días. Conclusión: En la reconstrucción y refuncionalización de la pared abdominal es una opción efectiva.

Introduction: the repair of incisional hernia using Rives-Stoppa technique is a technique, with low rates of recurrence (3 to 12 %) and complications (15 %). Objective: To describe the results in the application of the Rives-Stoppa technique in the treatment of incisional hernias. Patients and methods: study, observational, descriptive, retrospective, cross-sectional, with sampling non-probability, of consecutive cases, from January 2010 to December 2015. Results: n: 38 patients, being 33 (86.8 %) women and men 5 (13.2 %). The age average 52.5 years (20-78). The pathologies... The underlying pathologies: 33 (86.8 %). Location of incisional hernias, 36 (94.7 %) of the middle line and ventrolateral 2. Surgical history, the most frequent cesarean section 13 (34.2 %). Average operative time 116,7 minutes. We had 1 (2.6 %) local complications, bleeding tissue cell. Hospital stay average 2.3 days. Conclusion: In the reconstruction and reorganization of the abdominal wall is an effective option.

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Objetivo: La Técnica de Rives-Stoppa para las eventraciones de la línea media instala una malla retro rectal fijada en sus bordes con puntos percutáneos. Se han propuesto otras formas de fijación y en este estudio prescindimos de ella. Material y Método: El presente estudio observacional, descriptivo, prospectivo, se realizó en pacientes intervenidos consecutivamente entre los años 1995 y 2002. Se usó anestesia epidural con sedación profunda. Se usó la técnica estándar de Rives-Stoppa prescindiendo de la fijación perimetral. Los pacientes deambularon y se dieron de alta precozmente. Resultados: Se da cuenta de la evolución postoperatoria de 64 pacientes, 48 mujeres y 16 varones con una edad promedio de 58,9 (26-85) años. El 25 por ciento era hipertenso, el 9,3 por ciento diabético y el 80,2 por ciento obeso con un IMC > 30. La hospitalización promedio fue de 3,9 (2-16) días. Hubo 4 infecciones superficiales, un trombo embolismo pulmonar, un íleo abdominal prolongado y dos infecciones pulmonares. El seguimiento a largo plazo pudo realizarse en 48 pacientes (75 por ciento) comprobándose 5 recidivas (10,4 por ciento), ubicadas en el borde dista o proximal de la reparación herniaria, y 13,2 por ciento de dolor crónico moderado. A pesar de la recurrencia, el 97 por ciento de los pacientes se manifestó satisfecho o muy satisfecho con el tratamiento. Discusión: Los resultados son comparables con los dados a conocer con fijación de la malla. La modificación técnica propuesta disminuye el tiempo quirúrgico y el riego de infección y de neuralgia post operatoria. Para una ulterior disminución de las recidivas debe aumentarse el solapamiento cefálico y caudal de la malla.

Background: The Rives-Stoppa technique for midline incisional hernias places a Mersilene mesh in the retro rectal space, which is kept in place with transcutaneous sutures. Other forms of fixation have been proposed. Aim: To assess the long term results of the surgical technique without fixation of the mesh. Material and Methods: An observational, descriptive, prospective study performed in 64 patients aged 26 to 85 years (48 women) consecutively operated between 1995 and 2002. The standard Rives-Stoppa technique was used, except for the usage of a Prolene mesh without fixation. Ambulation was started on the first postoperative day and patients were discharged after removal of drains. Results: Eighty percent of patients were obese, 25% had high blood pressure and 9% were diabetic. Patients were discharged at a median of four (range two-16) days after surgery. Four superficial infections, one case of thromboembolic disease, one case of prolonged ileus and two pulmonary infections were recorded as complications. A long term follow-up was carried out in 48 patients (75%). Five patients had small recurrences (10%), localized at the cephalic or caudal borders of the mesh, and six patients (13%) reported slight abdominal pain. In spite of recurrences, 97% of patients were satisfied or very satisfied with the treatment. Conclusions: These results are similar to those obtained using mesh fixation. Increasing distal and proximal mesh overlap should enhance these results.

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