, Volume 23, Issue 5, pp 935–944 | Cite as

MILOS and EMILOS repair of primary umbilical and epigastric hernias

  • W. ReinpoldEmail author
  • M. Schröder
  • C. Berger
  • W. Stoltenberg
  • F. Köckerling
Original Article
Part of the following topical collections:
  1. Forum on primary midline uncomplicated ventral hernia



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.


Umbilical 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.

Ethical approval

The Herniamed database with anonymous prospective data collection has ethical approval.

Human and animal rights

Human and animal rights are respected.

Informed consent

All patients have given informed consent for inclusion in this trial.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery and Reference Hernia CenterGross Sand Hospital Hamburg, Academic Teaching Hospital of Hamburg University HospitalHamburgGermany
  2. 2.Department of Surgery and Center for Minimally Invasive SurgeryAcademic Teaching Hospital of Charité Medical School, Vivantes HospitalBerlinGermany

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