European Surgery

, Volume 49, Issue 2, pp 59–64 | Cite as

Minimally invasive sublay mesh repair of incisional and primary abdominal wall hernias using the MILOS technique

  • W. ReinpoldEmail author
  • M. Schröder
  • A. Schröder
  • C. Berger
  • J. Nehls
  • W. Stoltenberg
  • F. Köckerling
original article



Primary ventral and incisional hernia repair is a routine operation in general surgery. The most widely used techniques, however, have some disadvantages and risks. In order to minimize complications and postoperative pain, we developed the endoscopically assisted mini and less open sublay (MILOS) operation.


The surgical steps of this novel technique are described here. The operation is performed via a small incision transhernially 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.


The results and complication rates of 715 MILOS operations for incisional hernias are presented. The data of all MILOS operations were prospectively documented in the German hernia database “Herniamed.”


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.


Incisional hernia Ventral hernia Minimally invasive sublay repair Endoscopic ventral hernia repair Sublay technique Total extraperitoneal preperitoneal repair Endoscopic retromuscular hernia repair 


Conflict of interest

W. Reinpold, M. Schröder, A. Schröder, C. Berger, J. Nehls, W. Stoltenberg, and F. Köckerling declare that they have no competing interests.


  1. 1.
    Seiler CM, Deckert A, Diener MK, Knaebel HP, Weigand MA, Victor N, Büchler MW. Midline versus transverse incision in major abdominal surgery: a randomized, double-blind equivalence trial (POVATI: ISRCTN60734227). Ann Surg. 2009;249(6):913–20.CrossRefGoogle Scholar
  2. 2.
    Seiler CM, Bruckner T, Diener MK, Papyan A, Golcher H, Seidlmayer C, Franck A, Kieser M, Büchler MW, Knaebel HP. Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter r andomized trial (INSECT: ISRCTN24023541). Ann Surg. 2009;249(4):576–82.CrossRefGoogle Scholar
  3. 3.
    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
  4. 4.
    Rosen MJ, Jin J, McGee MF, Williams C, Marks J, Ponsky JL. Laparoscopic component separation in the single-stage treatment of infected abdominal wall prosthetic removal. Hernia. 2007;11(5):435–40.CrossRefGoogle Scholar
  5. 5.
    Schroeder AD, Debus ES, Schroeder M, Reinpold WM. Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias. Surg Endosc. 2013;27(2):648–54.CrossRefGoogle Scholar
  6. 6.
    Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, Köckerling F, Kukleta J, Leblanc K, Lomanto D, Misra MC, Bansal VK, Morales-Conde S, Ramshaw B, Reinpold W, Rim S, Rohr M, Schrittwieser R, Simon T, Smietanski M, Stechemesser B, Timoney M, Chowbey P, International Endohernia Society (IEHS). Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-part 1. Surg Endosc. 2014;28(1):2–29.CrossRefGoogle Scholar
  7. 7.
    Schroeder AD, Debus ES, Schroeder M, Reinpold WM. Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias. Surg Endosc. 2013;27(2):648–54. doi: 10.1007/s00464-012-2508-9.CrossRefGoogle Scholar
  8. 8.
    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
  9. 9.
    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
  10. 10.
    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.CrossRefGoogle Scholar
  11. 11.
    Conze J, Binnebösel M, Junge K, Schumpelick V. Narbenhernie – Wie ist zu verfahren? Chirurgische Standardversorgung. Chirurg. 2010;81(3):192–200.CrossRefGoogle Scholar
  12. 12.
    Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo PM, 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.CrossRefGoogle Scholar
  13. 13.
    Amid PK, Lichtenstein IL. Retromuscular alloplasty of large scar hernias: a simple staple attachment technique. Chirurg. 1996;67(6):648–52.PubMedGoogle Scholar
  14. 14.
    den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW. Open surgical procedures for incisional hernias. Cochrane Database Syst Rev. 2008; . doi: 10.1002/14651858.CD006438.CrossRefGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    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.CrossRefGoogle Scholar
  18. 18.
    Reinpold W. Endoskopisch totalextraperitonealer transhernialer Sublay –Bauchwand-Hernienverschluss in Single-Port-Technik. In: Schumpelick V, Arlt G, Conze J, Junge K, editors. Hernien, 5th edn. Stuttgart: Thieme; 2015. pp. 301–4.Google Scholar
  19. 19.
    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 (in preparation).Google Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • W. Reinpold
    • 1
    Email author
  • M. Schröder
    • 1
  • A. Schröder
    • 1
  • C. Berger
    • 1
  • J. Nehls
    • 1
  • W. Stoltenberg
    • 1
  • F. Köckerling
    • 2
  1. 1.Department of Surgery and Reference Hernia CenterGross Sand Hospital Hamburg WilhelmsburgHamburgGermany
  2. 2.Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical SchoolVivantes HospitalBerlinGermany

Personalised recommendations