THE MILOS TECHNIQUE: endoscopic assisted mini-open transhernial sublay repair of incision hernias. My experience with 202 patients

W. Reinpold

Moderator(s): Rene Fortelny (Vienna, Austria) & Salvador Morales Conde (Sevilla, Spain)

12:15 - 12:30h at Jurriaanse Zaal

Laparoscopic IPOM repair and open sublay repair are both established techniques for the cure of eventrations. IPOM meshes have to be fixated thoroughly with transmural sutures, staples or clips which carry the risk of additional adhesions and pain. Open sublay repair is associated with higher infection rates.

Material and Methods:
We developed an endoscopic assisted “mini-open”transhernial technique (MILOS) for the sublay repair of eventrations (MILOS): Endoscopic assisted dissection of the hernia sac, hernia defect and extraperitoneal plane allows the implantation of large alloplastic meshes with minimal atraumatic fixation and anatomical reconstruction of the abdominal wall. The operation can be performed in single port technique. The data of all patients were included into the German Hernia Registry and prospectively analysed. After one year all patients received a questionnaire and symptomatic patients were re-examined. A matched pair analysis with open sublay and laparoscopic IPOM patients of the German Hernia Registry was performed.

Twohunderedtwo MILOS operations of incisional hernias with an average defect size of 95.8cm², an average mesh size of 438cm² were included. There were 33% small, 45% medium size and 22% large incisional hernias. The largest meshes were 45x30 cm. The hernia defect was closed in all but two operations.

There were no bowel injuries and one infection. There were two reoperations, one due to large retromuscular hematoma one due a small bowel obstruction. One year follow-up was 89.1%: Chronic pain at rest and during activities were 4.6% and 8.9%, respectively. There were two recurrences. There were significantly less postoperative complications and chronic pain compared to open sublay and lap IPOM repair and highly significantly less infections compared to open sublay.

The MILOS operation combines the advantages of minimal access surgery and the open Sublay-Rives-Stoppa operation. 

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