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

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.