A new method of treating abdominal hernias

   Minimally invasive anterior abdominal wall surgery with plastic mesh using the MILOS technique has many advantages. With the MILOS technique it is possible to perform abdominal wall surgery for postoperative hernias with a significantly lower rate of complications and recurrences compared to traditional methods, rapid recovery of abdominal muscles, sports activities are possible after 1-2 weeks, good cosmetic result, significantly less postoperative pain.

Anterior abdominal wall hernias and postoperative hernias are among the most frequent diagnoses requiring surgical intervention. Approximately 150,000 procedures are performed in Germany per year. Anterior abdominal wall hernias and postoperative hernias, like inguinal hernias, are abnormal openings in the abdominal wall that do not heal on their own and carry a risk of impingement of the intestines and other internal organs, which occurs at a rate of approximately 1 to 2% per year.

The underlying cause appears to be a genetic weakness in connective tissue. Patients with hernia have fewer cross-links between collagen molecules, which are the building blocks of connective tissue. Postoperative hernia is the most common complication after abdominal surgery, accounting for 10 to 30%.

Today, doctors install a special mesh, which reduces the recurrence rate by more than 60% compared to conventional suturing. The laparoscopic method of mesh placement is widely used. In open surgery, the mesh is inserted through a large skin incision.

The use of meshes during hernia removal should be reduced, as its placement forms a connection with the intestine and other abdominal structures. This increases the risk of developing adhesions. Adhesions lead to intestinal obstruction, pronounced pain. In addition, when installing the mesh, staples and clips are used to fix it. Therefore, there is a risk of developing chronic postoperative pain. The IPOM technique uses mesh with a special coating that reduces the risk of intestinal obstruction. However, studies have shown that the risk of developing adhesions is not reduced with this technique. In addition, patients had many recurrences in the year after surgery, while there were fewer infectious complications.

With the MILOS technique, physicians aim for wall restoration with prior anatomic reconstruction of the abdominal wall.

Each operation in the MILOS technique begins with a small skin incision just above the center of the hernia. The skin incision has a maximum length of one quarter of the largest mesh diameter. Using laparoscopic instruments that are equipped with a lamp, the first stage of the operation is performed. After preparing at least 8 cm of space between the peritoneum and the abdominal wall, gas is introduced and a trocar is placed.

The MILOS technique allows the abdominal wall to be dissected outside the abdominal cavity. The MILOS technique also allows the full elasticity of the abdominal wall to be restored with a very good cosmetic result. There is virtually no postoperative pain.

The MILOS operation is currently considered the most «soft» surgical procedure for abdominal wall hernias. The concept of minimally invasive mesh placement in the abdominal cavity is currently one of the main topics at national and international congresses because of the disadvantages of conventional surgical methods and the very good results of the MILOS operation.

abdominal herniasmilos