The minimally invasive MILOS technique

For surgery on abdominal wall, umbilical and incisional hernias using minimally invasive techniques, the plastic meshes are usually placed in the abdominal cavity. No only can this lead to foreign body reactions but it also carries the risk that the mesh can adhere to the bowel loops, resulting in considerable complications and severe pain. More surgery is then often needed.

Dr Wolfgang Reinpold, Senior Surgical Consultant and Director of the Hernia Centre in the Wilhelmsburger Krankenhaus Groß-Sand in Hamburg-Wilhelmsburg, developed a surgical method in which the plastic meshes are implanted outside the abdominal cavity through a very small incision. This ensures that the mesh cannot adhere to the bowel because it no longer makes contact with it. The MILOS technique combines the advantages of keyhole surgery with those of the open technique.

What happens during the surgery?

Under general anaesthesia, a camera and the surgical instruments are inserted through a small incision. First, the bulging part of the peritoneum is removed and then sutured together again. With the help of endoscopic instruments, the mesh is then rolled out and fixed outside the abdominal cavity, that is, between the peritoneum that surrounds the internal organs and the connective tissue. The hernia defect is then closed using the plastic mesh. All that remains is a tiny scar.

You can see a small animation opposite about the MILOS technique.

TV reports on the MILOS technique and an interview with Dr Reinpold can be found here.

Advantages of the MILOS technique:

  • small incisions
  • considerably less pain after surgery compared to all other established surgical techniques
  • lower risk of complications such as bleeding, inflammation or organ damage
  • very good recovery of abdominal wall function
  • cosmetically good result
  • considerably reduced risk of recurrences (repeat hernias)
  • quick discharge from the hospital 
  • very rapid recovery of load bearing capacity
  • physical activity possible again after 1 to 2 weeks

Who can be operated on using the MILOS technique?

Like every medical treatment, the MILOS technique is not equally suited to every patient. Prior to the surgical treatment it is always necessary to carry out a detailed examination and precise diagnostics that takes into account any other conditions the patient may have. On the basis of these examinations, it is determined and discussed in detail with the patient whether a minimally invasive procedure is possible or whether an open procedure is the better option.

The following conditions are not suitable for the MILOS technique and are contraindications:

  • extremely large hernias with severe bulging
  • large lateral (on the side) incisional hernias
  • incisional hernias with large and wide scars
  • extreme adhesions between internal organs and abdominal wall
  • hernias for which safe hernia repair is only possible by extending the incision


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External quality assurance

Surgeons who use the MILOS technique are involved in the external quality assurance project of the Herniamed hernia registry. The main task of the society, founded in 2009, is an internet-based quality assurance study in which doctors who carry out hernia surgery can record their operations on the basis of an established scientific standard. The outcomes of the treatments are tracked for up to ten years. This ensures that any problems that occur later can be reliably followed. Specialist surgeons can work towards the best therapeutic outcomes for their patients on the basis of this information.