Gross-Sand Hospital Hamburg, Academic Teaching Hospital of Hamburg University Hospital, Hamburg, Germany.
Department of Surgery, Creighton University Hospital, Omaha, NE.
Ann Surg. 2019 Apr;269(4):748-755. doi: 10.1097/SLA.0000000000002661.
Improvement of ventral hernia repair.
Despite the use of mesh and other recent improvements, the currently popular techniques of ventral hernia repair have specific disadvantages and risks.
We developed the endoscopically assisted mini- or less-open sublay (MILOS) concept. The operation is performed transhernially via a small incision with light-holding laparoscopic instruments either under direct, or endoscopic visualization. An endoscopic light tube was developed to facilitate this approach (EndotorchTM Wolf Company). Each MILOS operation can be converted to standard total extraperitoneal gas endoscopy once an extraperitoneal space of at least 8 cm has been created. All MILOS operations were prospectively documented in the German Hernia registry with 1 year questionnaire follow-up. Propensity score matching of incisional hernia operations comparing the results of the MILOS operation with the laparoscopic intraperitoneal onlay mesh operation (IPOM) and open sublay repair from other German Hernia registry institutions was performed.
Six hundred fifteen MILOS incisional hernia operations were included. Compared with laparoscopic IPOM incisional hernia operation, the MILOS repair is associated with significantly a fewer postoperative surgical complications (P < 0.001) general complications (P < 0.004), recurrences (P < 0.001), and less chronic pain (P < 0.001). Matched pair analysis with open sublay repair revealed significantly a fewer postoperative complications (P < 0.001), reoperations (P < 0.001), infections (P = 0.007), general complications (P < 0.001), recurrences (P = 0.017), and less chronic pain (P < 0.001).
The MILOS technique allows minimally invasive transhernial repair of incisional hernias using large retromuscular/preperitoneal meshes with low morbidity. The technique combines the advantages of open sublay and the laparoscopic IPOM repair.ClinicalTrials.gov Identifier NCT03133000.
改善腹疝修复。
尽管使用了网片和其他最近的改进措施，但目前流行的腹疝修复技术仍存在特定的缺点和风险。
我们开发了内镜辅助微创或小切口下置片（MILOS）技术。该手术通过小切口进行，使用持光腹腔镜器械进行，或直接进行内镜可视化，或进行内镜可视化。为了便于这种方法，我们开发了一种内镜光管（Wolf 公司的 EndotorchTM）。一旦建立了至少 8cm 的腹膜外间隙，每个 MILOS 手术都可以转换为标准的全腹膜外气体内镜手术。所有 MILOS 手术均在德国疝登记处进行前瞻性记录，并进行了 1 年的问卷调查随访。对切口疝手术进行倾向评分匹配，比较 MILOS 手术与腹腔镜腹腔内补片修补术（IPOM）和来自其他德国疝登记处机构的开放式下置片修补术的结果。
共纳入 615 例 MILOS 切口疝手术。与腹腔镜 IPOM 切口疝手术相比，MILOS 修复术术后手术并发症（P<0.001）、一般并发症（P<0.004）、复发（P<0.001）和慢性疼痛（P<0.001）明显减少。与开放式下置片修补术的匹配对分析显示，术后并发症（P<0.001）、再次手术（P<0.001）、感染（P=0.007）、一般并发症（P<0.001）、复发（P=0.017）和慢性疼痛（P<0.001）明显减少。
MILOS 技术允许使用大的肌后/腹膜前网片进行微创经腹疝修复，具有低发病率。该技术结合了开放式下置片和腹腔镜 IPOM 修复的优点。
NCT03133000。
