Ventral Abdominal Hernia Repair: MIS Extraperitoneal Repair Techniques: eTEP Rives, MILOS/EMILOS, and Onlay MIS Repair

  • Flavio Malcher Martins de Oliveira
  • Leandro Totti Cavazzola
  • Adam S. Weltz
  • Igor Belyansky


Minimally invasive surgery (MIS) ventral hernia repairs were first described by Le Blanc in 1993 with the laparoscopic approach and an intraperitoneal onlay mesh (IPOM) implant. The development of laparoscopic techniques included several modifications such as the use of new coated meshes, new fixation devices, and, perhaps most importantly, changes in surgical technique. Laparoscopic techniques have proven themselves in the last 20 years as safe and effective treatments for ventral hernias, despite increased rates of intra-abdominal complications. Advances in MIS ventral hernia repair, such as the robotic platform, have enhanced the ability to operate on the abdominal wall through fully articulated instruments and improved optics and visualization. Surgeons quickly began performing MIS repairs without IPOM, returning to traditional techniques such as onlay and sublay. After robotic surgery ushered this trend, several MIS surgeons without robotic access began performing these techniques using traditional laparoscopic/endoscopic instruments. In this chapter, we will explore several of these extraperitoneal techniques.


Ventral abdominal hernia repair MIS extraperitoneal repair eTEP Rives MILOS/EMILOS Onlay MIS repair 


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Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2019

Authors and Affiliations

  • Flavio Malcher Martins de Oliveira
    • 1
  • Leandro Totti Cavazzola
    • 2
    • 3
  • Adam S. Weltz
    • 3
  • Igor Belyansky
    • 3
  1. 1.Montefiore Medical CenterBronxUSA
  2. 2.Hospital de Clínicas de Porto AlegrePorto AlegreBrazil
  3. 3.Department of SurgeryAnne Arundel Medical CenterAnnapolisUSA

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