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Updated: Jul 11, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
MILOS and EMILOS repair of primary umbilical and epigastric hernias
W Reinpold1, M Schröder2, C Berger2
1Department of Surgery and Reference Hernia Center, Gross Sand Hospital Hamburg, Academic Teaching Hospital of Hamburg University Hospital, Gross-Sand 3, 21107, Hamburg, Germany. wreinpold@gmx.net.
Background:
The currently mainly used techniques of primary ventral hernia repair have specific disadvantages and risks.
Methods:
To minimize complications of the existing open and laparoscopic techniques of ventral hernia repair, the endoscopic-assisted or endoscopic Mini- or Less-Open Sublay (E/MILOS) concept was developed. This paper reports on our experience with the E/MILOS concept for the management of primary umbilical and epigastric hernias. All E/MILOS operations were prospectively documented in the German hernia registry "Herniamed". For 1 year follow-up, all patients and their general practitioners received a questionnaire.
Results:
Five hundred and twenty primary umbilical and 554 epigastric E/MILOS operations with complete 1-year follow-up were included. Concomitant RD were treated in 18.3% and 14.1% of the umbilical and epigastric hernia cohort, respectively. Total perioperative complication rates and reoperation rates were 1.2% and 0.9% for both umbilical and epigastric hernias, respectively. Infection rates were 0.0% and 0.2% after umbilical and epigastric hernia operations, respectively. Recurrence rates 1 year after E/MILOS umbilical and epigastric hernia were 0.0% and 0.5%, respectively. One year rates of chronic pain at rest, chronic pain during physical activities, and chronic pain requiring treatment after umbilical and epigastric hernia repair were 1.5% and 2.7%, 2.1% and 4.2%, and 0.6% and 1.8%; respectively.
Conclusion:
The E/MILOS concept allows the endoscopically assisted (MILOS) or endoscopic (EMILOS) transhernial minimal invasive sublay mesh repair of primary umbilical and epigastric hernias with or without rectus diastasis with low complication, recurrence, and chronic pain rates.
