Advertisement

Endoscopically Assisted Mini or Less Open Sublay (MILOS) Mesh Repair of Abdominal Wall Hernias

  • W. Reinpold
Chapter

Abstract

Introduction: Primary ventral and incisional hernia repairs are among the most frequent operations in general surgery. However, despite the use of mesh and other recent improvements, the currently popular techniques have specific disadvantages and risks. In order to minimize complications and chronic pain, we developed the endoscopic-assisted mini or less open sublay (MILOS) operation. Methods: The surgical steps of the novel MILOS technique are described here. The operation is performed via a small incision with light-armed laparoscopic instruments either under direct visualization or endoscopic view. After creating an extraperitoneal space of at least 8 cm and CO2 insufflation, total extraperitoneal preperitoneal mesh repair (TEP) of ventral and incisional hernias can be performed. Results: The results and complication rates with 1-year follow-up of 865 MILOS operations for incisional hernias are presented. The data of all MILOS operations were prospectively documented in the German hernia database “Herniamed.” Conclusion: The MILOS technique facilitates minimally invasive transhernial repair of primary ventral and incisional hernias using large retromuscular/preperitoneal meshes. The technique is associated with a very low morbidity rate and with less chronic pain.

References

  1. 1.
    Usher FC, Ochsner J, Tuttle LL Jr. Use of marlex mesh in the repair of incisional hernias. Am Surg. 1958;24(12):969–74.PubMedGoogle Scholar
  2. 2.
    Rives J, Pire JC, Flament JB, Convers G. Treatment of large eventrations (apropos of 133 cases). Minerva Chir. 1977;32(11):749–56.PubMedGoogle Scholar
  3. 3.
    Stoppa R, Warlaumont C, Chantriaux JF. Prosthetic surgical treatment of inguinal hernias. Parietalization of the spermatic cord. Presse Med. 1984;13(38):2317–8.PubMedGoogle Scholar
  4. 4.
    Stoppa RE, Rives JL, Warlaumont CR, Palot JP, Verhaeghe PJ, Delattre JF. The use of Dacron in the repair of hernias of the groin. Surg Clin North Am. 1984;64(2):269–85.CrossRefPubMedGoogle Scholar
  5. 5.
    Conze J, Binnebösel M, Junge K, Schumpelick V. Narbenhernie—Wie ist zu verfahren? Chirurgische Standardversorgung Chirurg. 2010;81(3):192–200.CrossRefGoogle Scholar
  6. 6.
    Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A. Classification of primary and incisional abdominal wall hernias. Hernia. 2009;13(4):407–14. Epub 2009 Jun 3.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Amid PK, Lichtenstein IL. Retromuscular alloplasty of large scar hernias: a simple staple attachment technique. Chirurg. 1996;67(6):648–52.PubMedGoogle Scholar
  8. 8.
    den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW. Open surgical procedures for incisional hernias. Cochrane Database Syst Rev. 2008;3:CD006438. Review.Google Scholar
  9. 9.
    Forbes SS, Eskicioglu C, McLeod RS, Okrainec A. Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg. 2009;96(8):851–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig MK. Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg. 2009;197(1):64–72. Epub 2008 Jul 9. Review.CrossRefPubMedGoogle Scholar
  11. 11.
    Kapischke M, Schulz T, Schipper T, Tensfeldt J, Caliebe A. Open versus laparoscopic incisional hernia repair: something different from a meta-analysis. Surg Endosc. 2008;22(10):2251–60. Epub 2008 Mar 5. Review.CrossRefPubMedGoogle Scholar
  12. 12.
    Reinpold W. Endoskopisch totalextraperitonealer transhernialer Sublay—Bauchwand-Hernienverschluss in Single-Port-Technik. In: Schumpelick V, Arlt G, Conze J, Junge K, editors. Hernien. 5th ed. Stuttgart: Thieme; 2015. p. 301–4.Google Scholar
  13. 13.
    Reinpold W, Schröder M, Berger C, Stoltenberg W, Schröder A, Nehls J, Hukauf M, Adolf D, Bittner R, Köckerling F. Mini- or less open sublay operation (MILOS)—a new minimally invasive technique for the extraperitoneal repair of incisional hernias. Ann Surg. 2018.  https://doi.org/10.1097/SLA.0000000000002661.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery and Reference Hernia CenterGross Sand Hospital Hamburg WilhelmsburgHamburgGermany

Personalised recommendations