Vol.:(0123456789) 1 3 Hernia (2019) 23:935–944 https://doi.org/10.1007/s10029-019-02056-x ORIGINAL ARTICLE MILOS and EMILOS repair of primary umbilical and epigastric hernias W. Reinpold 1  · M. Schröder 1  · C. Berger 1  · W. Stoltenberg 1  · F. Köckerling 2 Received: 15 September 2019 / Accepted: 17 September 2019 / Published online: 30 September 2019 © Springer-Verlag France SAS, part of Springer Nature 2019 Abstract Background The currently mainly used techniques of primary ventral hernia repair have specifc disadvantages and risks. Methods To minimize complications of the existing open and laparoscopic techniques of ventral hernia repair, the endo- scopic-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. Keywords Umbilical hernia · Epigastric hernia · Endoscopic retromuscular hernia repair · Endoscopic ventral hernia repair · Minimal invasive sublay repair · Primary abdominal wall hernia Introduction Primary ventral hernias are the second most common her- nias worldwide. In Germany, more than 100,000 primary ventral hernias are operated on every year. According to the current evidence in the literature, mesh-related operation techniques are associated with lower recurrence rates than suture repair [1–13]. A recent publication from the Danish Database concludes that even small hernia defects require the use of mesh [10]. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence [14]. Laparoscopic intraperitoneal onlay mesh (IPOM) repair and open sublay mesh repair are currently the most widely used techniques for the treatment of primary and recurrent abdominal wall hernias worldwide [1–9, 11]. While the open techniques are burdened with higher wound complication rates [3–9, 11], the lap. IPOM repair carries an increased risk of intraoperative bowel injury, adhesions, and bowel obstruction [4, 6, 11]. Despite the development of coated meshes designed to lower risk of adhesion forma- tion, the potential risks associated with an intraperitoneal foreign body have not yet been eliminated [4–8, 11] and traumatic mesh fxation increases the risk of adhesions, vis- ceral damage, nerve injury, acute, and chronic pain [4–8, 11, 15]. According to the current evidence, the retromus- cular/preperitoneal (= sublay) space is the best option for * W. Reinpold wreinpold@gmx.net 1 Department of Surgery and Reference Hernia Center, Gross Sand Hospital Hamburg, Academic Teaching Hospital of Hamburg University Hospital, Gross-Sand 3, 21107 Hamburg, Germany 2 Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585 Berlin, Germany