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Endoscopic mini/less open sublay technique (EMILOS)—a new technique for ventral hernia repair

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Abstract

Introduction

The “MILOS concept” (mini/less open sublay repair) was developed to realize the benefits of minimally invasive surgery and avoid the disadvantages of traditional open techniques in repair of primary and secondary abdominal wall hernias. Utilizing the MILOS concept, the mesh can be placed in the retromuscular position without opening of the abdominal cavity or without the necessity to perform a large skin incision. The dissection of the retromuscular plane may be done by an open technique (MILOS) or endoscopically (EMILOS).

Patients and methods

From June 2015 to July 2016, a total of 33 patients were operated using the MILOS concept, 8 patients underwent the original MILOS technique, and 25 patients had the EMILOS operation. The operative steps of this novel endoscopic variation, the EMILOS procedure (endoscopic mini/less open sublay), are described in detail. Operative indications were a midline umbilical, epigastric, or incisional hernia with a coexisting rectus diastasis. In all cases, a large mesh (20 × 30) was implanted in the retromuscular space without any fixation.

Results

The average skin incision was 5.2 cm; mean operative time was 157 min and 122 min in the last five cases. The average hospital stay was 3.2 days. The median pain score (VAS) under physical stress (e.g., climbing stairs) was 2.7.

Conclusion

The EMILOS operation has the potential to become an important supplementary method in the spectrum of surgical techniques for repair of abdominal wall hernias. The technique is reliable, reproducible, and easy to standardize.

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Acknowledgments

We would like to thank David Chen, M.D., Associate Professor of Clinical Surgery, Clinical Director, Lichtenstein Amid Hernia Clinic at UCLA, Section of Minimally Invasive Surgery, UCLA Division of General Surgery, for editing the manuscript.

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Authors and Affiliations

  1. Hernia Center Rottenburg, Röntgenstr.38, 72108, Rottenburg a.N, Germany

    J. Schwarz & Reinhard Bittner

  2. Hernia Center, Wilhelmsburger Krankenhaus Groß-Sand, Groß-Sand 3, 21107, Hamburg, Germany

    W. Reinpold

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  1. J. Schwarz
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The authors declare that they have no conflict of interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Schwarz, J., Reinpold, W. & Bittner, R. Endoscopic mini/less open sublay technique (EMILOS)—a new technique for ventral hernia repair. Langenbecks Arch Surg 402, 173–180 (2017). https://doi.org/10.1007/s00423-016-1522-0

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  • DOI: https://doi.org/10.1007/s00423-016-1522-0

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