MILOS and EMILOS repair of primary umbilical and epigastric hernias
The currently mainly used techniques of primary ventral hernia repair have specific disadvantages and risks.
To minimize complications of the existing open and laparoscopic techniques of ventral hernia repair, the endoscopic-assisted or endoscopic Mini- or Less-Open Sublay (E/MILOS) concept was developed. This paper reports on our experience with the E/MILOS concept for the management of primary umbilical and epigastric hernias. All E/MILOS operations were prospectively documented in the German hernia registry “Herniamed”. For 1 year follow-up, all patients and their general practitioners received a questionnaire.
Five hundred and twenty primary umbilical and 554 epigastric E/MILOS operations with complete 1-year follow-up were included. Concomitant RD were treated in 18.3% and 14.1% of the umbilical and epigastric hernia cohort, respectively. Total perioperative complication rates and reoperation rates were 1.2% and 0.9% for both umbilical and epigastric hernias, respectively. Infection rates were 0.0% and 0.2% after umbilical and epigastric hernia operations, respectively. Recurrence rates 1 year after E/MILOS umbilical and epigastric hernia were 0.0% and 0.5%, respectively. One year rates of chronic pain at rest, chronic pain during physical activities, and chronic pain requiring treatment after umbilical and epigastric hernia repair were 1.5% and 2.7%, 2.1% and 4.2%, and 0.6% and 1.8%; respectively.
The E/MILOS concept allows the endoscopically assisted (MILOS) or endoscopic (EMILOS) transhernial minimal invasive sublay mesh repair of primary umbilical and epigastric hernias with or without rectus diastasis with low complication, recurrence, and chronic pain rates.
KeywordsUmbilical hernia Epigastric hernia Endoscopic retromuscular hernia repair Endoscopic ventral hernia repair Minimal invasive sublay repair Primary abdominal wall hernia
Compliance with ethical standards
Conflict of interest
There was no funding of the trial. The authors have nothing to disclose.
The Herniamed database with anonymous prospective data collection has ethical approval.
Human and animal rights
Human and animal rights are respected.
All patients have given informed consent for inclusion in this trial.
- 6.Sauerland S, Walgenbach M, Habermalz B et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 16(3):CD007781Google Scholar
- 21.Reinpold W (2015) Endoskopisch totalextraperitonealer transhernialer Sublay—Bauchwand-hernienverschluss in single-port-technik. In: Schumpelick V, Arlt G, Conze J, Junge K (eds) Hernien, 5th edn. Thieme, Stuttgart, pp 301–304Google Scholar
- 28.Köckerling F, Botsinis MD, Reinpold W et al (2016) Endoscopic-assisted linea alba reconstruction plus mesh augmentation for treatment of umbilical and/or epigastric hernias and rectus abdominis diastasis—early results. Front Surg 3:1–6Google Scholar
- 30.Moore AM, Anderson LN, Chen DC (2016) Laparoscopic stapled sublay repair with self-gripping mesh: a simplified technique for minimally invasive extraperitoneal ventral hernia repair. Surg Technol Int 26:131–139Google Scholar