Endoscopic Mini-or Less-Open Sublay Operation (E/MILOS) in ventral hernia repair: a minimally invasive alternative technique
The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperito...
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Published in | Revista do Colegio Brasileiro de Cirurgioes Vol. 50; p. e20233405 |
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Colégio Brasileiro de Cirurgiões
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Abstract | The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo. |
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AbstractList | ABSTRACT The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo. ABSTRACT The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo. RESUMO O tratamento cirúrgico ideal para correção das hérnias ventrais ainda é motivo de grande discussão1. O fechamento do defeito associado a utilização de telas para reforço da parede abdominal são passos fundamentais da terapia cirúrgica, podendo ser realizados tanto pela via aberta quanto pelas técnicas minimamente invasivas2. A via aberta apresenta maiores taxas de infecção de sítio cirúrgico, enquanto o reparo laparoscópico IPOM (intraperitoneal onlay mesh) acarreta um risco aumentado de lesões intestinais, aderências e obstruções intestinais, além de requerer uso de telas de dupla face e dispositivos de fixação que encarecem o procedimento e não raro aumentam a dor no pós-operatório3-5. A técnica eTEP (extended/enhanced view totally extraperitoneal), tem ganhado importância, mostrando-se uma boa opção para a correção das hérnias ventrais também2. A fim de se evitar as desvantagens das técnicas abertas e laparoscópicas “clássicas” o conceito MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair), desenvolvido por W. Reinpold et al. em 2009, 3 anos antes do advento do eTEP, possibilita ao cirurgião o uso de telas de grandes dimensões no plano retromuscular através de uma pequena incisão na pele e dissecção laparoscópica deste espaço, conforme modificação realizada em 2016, evitando a colocação de uma tela no espaço intraperitoneal6-7. Esta nova técnica passou a se chamar EMILOS (Endoscopic Mini or Less Open Sublay Repair)8 Este artigo tem como objetivo relatar nossa experiência inicial no emprego da técnica E-MILOS no Brasil, na Santa Casa de Misericórdia de São Paulo. The ideal ventral hernia surgical repair is still in discussion 1 . The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques 2 . The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain 3-5 . The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement 6,7 . This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair) 8 . The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo. The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo. |
Author | Reinpold, Wolfgang Amaral, Pedro Henrique DE Freitas Francis, Maurice Youssef Antunes, Pedro DE Souza Lucarelli Roll, Sergio DE-Carvalho, João Paulo Venancio Dias, Eduardo Rullo Maranhão Macret, Jessica Zilberman Ribeiro, Hamilton Brasil Pivetta, Luca Giovanni Antonio |
AuthorAffiliation | 3 - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - Serviço de Cirurgia do Aparelho Digestivo - São Paulo - SP - Brasil 6 - Irmandade da Santa Casa de Misericórdia de São Paulo, Médico Residente em Cirurgia Geral, Departamento de Cirurgia - São Paulo - SP - Brasil 8 - Helios Mariahilf Hospital Hamburg, Teaching Hospital of Hamburg Medical School, Chairman of the Department of Abdominal Wall Surgery - Hamburgo - Alemanha 1 - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pós-graduação em Cirurgia - São Paulo - SP - Brasil 2 - Irmandade da Santa Casa de Misericórdia de São Paulo, Grupo de Parede Abdominal - São Paulo - SP - Brasil 5 - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Professor da Disciplina de Cirurgia - São Paulo - SP - Brasil 4 - Irmandade da Santa Casa de Misericórdia de São Paulo, Médico Assistente do Serviço de Emergência - São Paulo - SP - Brasil 7 - Hamburg Hernia Center, Chairman and CEO - Hamburgo - Alemanha |
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References | Awaiz A (ref5) 2015; 19 Reinpold W (ref7) 2019; 23 Bittner R (ref1) 2019; 33 Sauerland S (ref3) 2011 Reinpold W (ref6) 2019; 269 Schwarz J (ref8) 2017; 402 Amaral MVFD (ref10) 2017; 44 Mitura K (ref2) 2020; 92 Arita NA (ref4) 2015; 29 ElHawary H (ref9) 2021; 25 |
References_xml | – start-page: CD007781 issue: 3 year: 2011 ident: ref3 article-title: Laparoscopic versus open surgical techniques for ventral or incisional hernia repair publication-title: Cochrane Database Syst Rev contributor: fullname: Sauerland S – volume: 44 start-page: 216 issue: 2 year: 2017 ident: ref10 article-title: Robotic Transversus Abdominis Release (TAR) is it possible to offer minimally invasive surgery for abdominal wall complex defects? publication-title: Rev Col Bras Cir doi: 10.1590/0100-69912017002009 contributor: fullname: Amaral MVFD – volume: 29 start-page: 1769 issue: 7 year: 2015 ident: ref4 article-title: Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias publication-title: Surg Endosc doi: 10.1007/s00464-014-3859-1 contributor: fullname: Arita NA – volume: 25 start-page: 827 issue: 4 year: 2021 ident: ref9 article-title: Closing the gap evidence-based surgical treatment of rectus diastasis associated with abdominal wall hernias publication-title: Hernia doi: 10.1007/s10029-021-02460-2 contributor: fullname: ElHawary H – volume: 92 start-page: 48 issue: 3 year: 2020 ident: ref2 article-title: New techniques in ventral hernia surgery - an evolution of minimally-invasive hernia repairs publication-title: Pol Przegl Chir contributor: fullname: Mitura K – volume: 23 start-page: 935 issue: 5 year: 2019 ident: ref7 article-title: MILOS and EMILOS repair of primary umbilical and epigastric hernias publication-title: Hernia doi: 10.1007/s10029-019-02056-x contributor: fullname: Reinpold W – volume: 402 start-page: 173 issue: 1 year: 2017 ident: ref8 article-title: Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair publication-title: Langenbecks Arch Surg doi: 10.1007/s00423-016-1522-0 contributor: fullname: Schwarz J – volume: 19 start-page: 449 issue: 3 year: 2015 ident: ref5 article-title: Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia publication-title: Hernia doi: 10.1007/s10029-015-1351-z contributor: fullname: Awaiz A – volume: 269 start-page: 748 issue: 4 year: 2019 ident: ref6 article-title: Mini- or Less-open Sublay Operation (MILOS) A New Minimally Invasive Technique for the Extraperitoneal Mesh Repair of Incisional Hernias publication-title: Ann Surg doi: 10.1097/SLA.0000000000002661 contributor: fullname: Reinpold W – volume: 33 start-page: 3069 issue: 10 year: 2019 ident: ref1 article-title: Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A publication-title: Surg Endosc doi: 10.1007/s00464-019-06907-7 contributor: fullname: Bittner R |
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Snippet | The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or... ABSTRACT The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open... The ideal ventral hernia surgical repair is still in discussion 1 . The defect closure with a mesh-based repair is the base of surgical repair, in open or... |
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SubjectTerms | Brazil Hand-Assisted Laparoscopy Hernia, Ventral Hernia, Ventral - surgery Herniorrhaphy - methods Humans Incisional Hernia - surgery Laparoscopy Laparoscopy - methods Surgical Mesh Technical Note Video-Assisted Surgery |
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Title | Endoscopic Mini-or Less-Open Sublay Operation (E/MILOS) in ventral hernia repair: a minimally invasive alternative technique |
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