Table 2.

Surgical approaches to the anterior pelvic ring.

Approach	Approachable structures	Possible complications	Avoid complications
Pfannenstiel approach7,8	Symphysis, Medial upper pubic bones	Injury of peritoneum	Mid-line dissection
		Injury of inferior epigastric artery	Mid-line dissection
		Injury of bladder	Place urinary catheter preoperatively, Blunt dissection of retrosymphyseal space
		Injury of Corona mortis	Avoid dissection too far lateral
		Injury of spermatic cord	Mid-line dissection
		Incisional hernia	Limited dissection of muscles from upper pubic bone, transosseous refixation if necessary
Modified Stoppa (intrapelvine) approach (+1st window of ilioinguinal approach)10	Symphysis, Whole upper pubic bones, Anterior acetabulum column, Quadrilateral plate, (sacroiliac joint)	Injury of peritoneum	Mid-line dissection
		Injury of inferior epigastric artery	Mid-line dissection
		Injury of bladder	Place urinary catheter preoperatively, Blunt dissection of retrosymphyseal space
		Injury of Corona mortis	Identify the vessel in the middle of the upper pubic bone and ligate it
		Injury of spermatic cord	Mid-line dissection
		Injury of vasa obturatoria	Subperiosteal dissection underneath obturator internus muscle
		Injury of obturator nerve	Subperiosteal dissection underneath obturator internus muscle
		Injury of sciatic nerve	Avoid deep dissection along quadrilateral plate
		Incisional hernia	Limited dissection of muscles from upper pubic bone, transosseous refixation if necessary
EASY approach (endoscopic approach to the symphysis)13	Symphysis, Whole upper pubic bones, Anterior acetabulum column, Quadrilateral plate, Sacroiliac joint	Injury of the peritoneum	Stop dissection, if sight is not optimal