Endoscopic mini/less open sublay operation for treatment of primary and secondary ventral hernias of the abdominal wall

Background Primary and secondary ventral hernias of the abdominal wall are very common conditions; however, the ideal operative treatment has not been found yet. Methods In the traditional open sublay technique, a large trauma to the abdominal wall must be accepted, which carries a high risk of infection, while the laparoscopic intraperitoneal onlay mesh (IPOM) technique is burdened with the need for special and expensive meshes and fixation devices as well. Moreover, the IPOM technique carries a significant risk of bowel injury. In order to avoid the disadvantages of these techniques, we developed an endoscopic technique (endoscopic mini/less open sublay; EMILOS) that allows for complete dissection of the retromuscular space for placement of a huge mesh to reinforce the whole anterior abdominal wall, while performing a 5-cm skin incision only. Results From June 2015 to January 2017, a total of 50 patients were operated on using the MILOS concept, nine patients underwent the original MILOS technique, and 41 patients had the EMILOS operation. The operative steps of this novel endoscopic variation, the EMILOS procedure, are described in detail. The average skin incision was 5.1 cm (3-8), and mean operative time was 160 min (90-255). In 38 patients the size of the mesh was 30 x 20 cm, in two patients 30 x 16 cm, and in one patient 15 x 15 cm. The average hospital stay was 3.2 days. The median pain score (VAS) under physical stress (e. g., climbing stairs) was 2.7. Conclusion The first results of the EMILOS operation are promising. The technique is standardized, reproducible, cost-effective, and allows one to place a large mesh into the retromuscular position, while avoiding severe trauma to the abdominal wall and the transabdominal route.