Summary of the advantages of the MILOS technique

Compared to laparoscopic IPOM and open sublay repairs, the MILOS repair offers a range of advantages. The most important advantages are:

• minimal trauma at the access site
• complete adhesiolysis usually not necessary
• full mobilisation of the hernia sac possible
• extraperitoneal mesh implantation without traumatic fixation
• use of standard meshes possible
• virtually tension-free closure of the hernia defect is usually assured
• less acute and chronic pain than after lap IPOM and open sublay repair (according to the matched pair analysis of 200 patients each in the German hernia registry Herniamed)
• fewer injuries to organs during surgery, less bleeding and fewer infections, revision surgeries and recurrences than after lap IPOM repair and open sublay repair (according to the Herniamed matched pair analysis)
• savings in material costs compared to laparoscopic IPOM repairs of about €1,200.00

Contraindications

The MILOS technique is not possible for some initial situations. Fundamental contraindications include:

• extremely large hernias with severe bulging, loss of domain, excess skin
• large lateral incisional hernias
• incisional hernias with large and wide scars and/or pathological scars
• extreme adhesions between the internal organs and the abdominal wall
• all hernias where extension of the incision allows safe hernia repair