The MILOS technique is a new endoscopically assisted method for minimally invasive extraperitoneal mesh implantation for abdominal wall and incisional hernias. The good results obtained over many years for laparoscopic inguinal hernia surgery and open sublay repair for abdominal wall hernias prompted Dr Wolfgang Reinpold and his team in the Hernia Centre of the Groß-Sand Krankenhaus in Hamburg-Wilhelmsburg to develop the innovative method in which the plastic mesh is implanted outside the abdominal cavity. The MILOS technique is also suitable for treating very large incisional hernias.
Differentiation from laparoscopic IPOM repairs
Currently, IPOM and open sublay repairs are the most commonly used techniques in Germany with each used to treat about one-third of abdominal wall and incisional hernias. According to currently available studies, infections occur more frequently after open sublay repairs. Laparoscopic IPOM repair is associated with a higher rate of seromas and bowel injuries during surgery but also have other disadvantages:
- The implantation of the plastic mesh in the abdominal cavity carries a higher risk of adhesions and bowel injury.
- Because the plastic meshes must be firmly attached to the peritoneum with numerous staples and sutures, the risk of nerve and muscle damage is increased.
- Closure of the hernia defects is difficult, which is why it is often omitted.
- The hernia sac is often left in the abdominal wall.
- Coated plastic implants must always be used. These do not reliably prevent adhesions and are also more expensive than standard meshes.
- Large hernias with a defect diameter greater than 10 cm are not suitable for laparoscopic IPOM repair.
Summary of the advantages of the MILOS technique
Compared to laparoscopic IPOM and open sublay repairs, the MILOS repair offers a range of advantages.