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MILOS Repair of Abdominal Wall Hernias
363
33
. Table33.3 MILOS incisional hernia repair at
Gross-Sand Hospital (n=715) vs. all incisional
hernias in the Herniamed register (23.682)
MILOS
incisional
hernia
operations
% (n=715)
No complications 96.0 86.0
Total number of
complications
Surgical complications
Haemorrhage/
postoperative
haemorrhage
Intestinal injury/
suture insuciency
Impaired wound
healing
Seroma 0.8 4.1
Infection 0.3 1.2
Ileus 0.1 1.2
Revision surgeries 1.8 4.1
General complications
Mortality 0.1 0.3
4.0 14.0
2.3 9.6
0.7 1.9
0.1 0.5
0.3 0.7
1.6 4.1
All incisional
hernia
operations
in Herniamed register
(23.682)
33.1 Summary
Our experience with over 1400 MILOS surgeries
in abdominal wall and incisional hernias showed
the following advantages of using this technique:
1. Minimally invasive extraperitoneal implantation of (large) standard synthetic meshes
without traumatic mesh xation.
2. Closure of hernia gaps and anatomical
reconstruction of the abdominal wall.
Protection of viable abdominal wall structures including nerves.
3. Aer MILOS operations, there were signicantly less postoperative surgical complications, general complications and less chronic
. Table33.4 MILOS incisional hernia operations
at Gross-Sand Hospital (n=600) vs. all incisional
hernias operations documented in Herniamed
register (n=12.621) with follow-up of 1year
MILOS
incisional
hernia
surgeries
(n=600)
% %
Recurrence after
1 year
Pain at rest 3.8 10.0 (9.9
Chronic
stress- induced
pain
Chronic pain
requiring
therapy
1.3 5.5 (6.8 lapIPOM;
6.5 18.5 (19.9
3.0 7.3 (7.7 lapIPOM
Incisional
hernias in
Herniamed
register
(n=12.621)
3.9 open sublay)
lapIPOM; 3.9 10.1
open sublay) 3.9
lapIPOM; 17.1
open sublay)
6.9 open sublay)
pain than aer open sublay and lapIPOM
repair. ere were signicantly less infections
aer MILOS repair compared to open sublay
and signicantly less recurrences than aer
lapIPOM repair (Herniamed register).
4. e MILOS technique allows minimally
invasive treatment of rectus diastases.
5. e MILOS technique can be combined with
endoscopic anterior and posterior component
separation.
6. Good cosmetic results.
7. In comparison with lapIPOM operations,
there is a saving of around 1.200 € in material
costs per operation.
References
1. Seiler CM, Deckert A, Diener MK, Knaebel HP, Weigand
MA, Victor N, etal. Midline versus transverse incision in
major abdominal surgery: a randomized, double-blind
equivalence trial (POVATI: ISRCTN60734227). Ann
Surg. 2009;249(6):913–20.
2. Seiler CM, Bruckner T, Diener MK, Papyan A, Golcher H,
Seidlmayer C, etal. Interrupted or continuous slowly
absorbable sutures for closure of primary elective
364
W. Reinpold
33
midline abdominal incisions: a multicenter randomized trial (INSECT: ISRCTN24023541). Ann Surg.
2009;249(4):576–82.
3. Usher FC, Ochsner J, Tuttle LL Jr. Use of marlex mesh in
the repair of incisional hernias. Am Surg.
1958;24(12):969–74.
4. Rives J, Pire JC, Flament JB, Convers G.Treatment of
large eventrations (apropos of 133 cases). Minerva
Chir. 1977;32(11):749–56.
5. Stoppa R, Warlaumont C, Chantriaux JF.Prosthetic surgical treatment of inguinal hernias. Parietalization of
the spermatic cord. Presse Med. 1984;13(38):2317–8.
6. Stoppa RE, Rives JL, Warlaumont CR, Palot JP,
Verhaeghe PJ, Delattre JF.The use of Dacron in the
repair of hernias of the groin. Surg Clin North Am.
1984;64(2):269–85.
7. Conze J, Binnebösel M, Junge K, Schumpelick
V.Narbenhernie – Wie ist zu verfahren? Chirurgische
Standardversorgung. Chirurg. 2010;81(3):192–200.
8. Forbes SS, Eskicioglu C, McLeod RS, Okrainec A.Metaanalysis of randomized controlled trials comparing
open and laparoscopic ventral and incisional hernia
repair with mesh. Br J Surg. 2009;96(8):851–8.
9. Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig
MK. Laparoscopic versus open repair of incisional/
ventral hernia: a meta-analysis. Am J Surg.
2009;197(1):64–72. Epub 2008 Jul 9. Review
10. Kapischke M, Schulz T, Schipper T, Tensfeldt J, Caliebe
A. Open versus laparoscopic incisional hernia repair:
something dierent from a meta-analysis. Surg Endosc.
2008;22(10):2251–60. Epub 2008 Mar 5. Review
11. Muysoms FE, Miserez M, Berrevoet F, Campanelli G,
Champault GG, Chelala E, et al. Classication of primary and incisional abdominal wall hernias. Hernia.
2009;13(4):407–14. Epub 2009 Jun 3
12. Amid PK, Lichtenstein IL.Retromuscular alloplasty of
large scar hernias: a simple staple attachment technique. Chirurg. 1996;67(6):648–52.
13. Rosen MJ, Jin J, McGee MF, Williams C, Marks J, Ponsky
JL.Laparoscopic component separation in the singlestage treatment of infected abdominal wall prosthetic removal. Hernia. 2007;11(5):435–40. Epub 2007
Jul 24.
14. den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW.Open
surgical procedures for incisional hernias. Cochrane
Database Syst Rev. 2008;(3):CD006438. Review.
15. Schroeder AD, Debus ES, Schroeder M, Reinpold
WM.Laparoscopic transperitoneal sublay mesh repair:
a new technique for the cure of ventral and incisional
hernias. Surg Endosc. 2013;27(2):648–54.
16. Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli
GS, Fortelny RH, Köckerling F, Kukleta J, Leblanc K,
Lomanto D, Misra MC, Bansal VK, Morales-Conde S,
Ramshaw B, Reinpold W, Rim S, Rohr M, Schrittwieser
R, Simon T, Smietanski M, Stechemesser B, Timoney M,
Chowbey P, International Endohernia Society (IEHS).
Guidelines for laparoscopic treatment of ventral and
incisional abdominal wall hernias (International
Endohernia Society (IEHS)-part 1). Surg Endosc.
2014;28(1):2–29. Epub 2013 Oct 11.
17. Reinpold W.Endoskopisch totalextraperitonealer transhernialer Sublay –Bauchwand- Hernienverschluss in
Single-Port-Technik. In: Schumpelick V, Arlt G, Conze J,
Junge K, editors. Hernien. 5th ed. Stuttgart: Thieme;
2015. p.301–4.
18. Schwarz J, Reinpold W, Bittner R. Endoscopic mini/less
open sublay technique (EMILOS)—a new technique
for ventral hernia repair. Langenbeck’s Arch Surg.
2017;402(1):173–180. doi: 10.1007/s00423-016-1522-0.
Epub 2016.
Endoscopic Mini/Less
Open Sublay (EMILOS)
Technique: AVariation
oftheMILOS Operation
intheTherapeutic
Spectrum ofPrimary
andSecondary Ventral
Hernias
ReinhardBittner andJochenSchwarz
365
34
34.1 Introduction – 366
34.2 Operative Technique – 366
34.3 Preliminary Results – 370
34.4 Discussion – 371
34.5 Conclusion – 371
References – 371
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
R. Bittner et al. (eds.), Laparo-endoscopic Hernia Surgery,
https://doi.org/10.1007/978-3-662-55493-7_34
366
R. Bittner and J. Schwarz
34
34.1 Introduction
e optimal operative treatment of primary and
secondary hernias of the abdominal wall is still
debatable. Traditional open techniques are burdened with a high rate of infection [1], whereas
the laparoscopic intraperitoneal onlay mesh
(IPOM) repair carries an increased risk for intraoperative lesions to the bowel, adhesions, and
bowel obstructions [2–4]. Despite great progress
in mesh technology and development of expensive meshes promising less formation of adhesions between the mesh and the intestine, the
potential risk of an intraperitoneal foreign body
has not yet been solved [5]. Furthermore, the
IPOM technique typically requires expensive xation devices and, more important, xation with
tacks or sutures causes severe acute and chronic
pain. In order to avoid these disadvantages of current open and laparoscopic techniques, the
MILOS (mini/less open sublay) concept was
developed by W.Reinpold (7 Chap. 33). e aim
of this novel technique is to keep the mesh out of
the abdominal cavity. Following the MILOS concept, the surgeon is able to place a large mesh into
the retromuscular plane through a small skin
incision (2–6 cm = mini open; 6–12 cm = less
open). e MILOS operation is an open procedure, using endoscopic dissection instruments
and a novel specically designed light tube which
facilitates exposure, visualization, and retraction
(Endotorch, Wolf TM). Despite this new innovative device, the technique which is extensively
described in 7 Chap. 33 may be technically challenging especially not at least because the assisting surgeon’s view is limited. erefore, in order
to increase utilization of the “MILOS concept,” we
developed the endoscopic mini/less open sublay
(EMILOS) operation which is essentially a
reversed total extraperitoneal(TEP) procedure
[6]. is variation of the original MILOS operation is a true hybrid technique which consists of
two parts, the rst steps (step 1–4) are identical to
the MILOS operation, then immediately aer
opening of the rectus sheath, the operation continues with endoscopic dissection “reversed TEP”
of the total retromuscular space.
34.2 Operative Technique
Aer initiation of general anesthesia, the patient
is placed at on the operating table with the legs
in the French position like performing a laparoscopic cholecystectomy (. Fig.34.1a, b).
During the endoscopic part of the operation,
the surgeon will stand between the legs of the
patient. No special instruments are needed
except a self-constructed low-cost indigenous
balloon [7, 8] used to develop the preperitoneal
space just proximal to the pubic bone as in
TEP.Steps 1 to 4 are identical to the MILOS operation (see 7 Chap. 33).
Step 1 e endoscopic part (E) of the MILOS
operation begins with a small incision of the posterior sheath of the rectus muscle on one side. e
rims of the opened fascia are marked with holding
sutures.
Step 2 Introducing of a curved sponge forceps
(Kornzange) into the rectus sheath and pushing
down directly on the back wall of the sheath in caudal direction toward the symphysis.
. Fig.34.1 a Typical
patient for an EMILOS
operation: umbilical hernia
with rectus diastasis.
b Position of the patient on
the operating table
a
b
Endoscopic Mini/Less Open Sublay (EMILOS) Technique
367
34
. Fig.34.2 Indigenous balloon [7, 8]
. Fig.34.3 The balloon is pushed down into the
suprapubic extraperitoneal space
Step 3 Removal of the forceps and replacement
by an indigenous balloon-like in TEP [7, 8]. e
balloon is prepared by capping the tip of a 5mm
suction irrigation cannula with the middle nger of
a number 8 latex glove (. Fig.34.2). e nger of
the glove is tied tightly onto the tip of the cannula
with some bandage material or some sutures.
Before introducing into the retromuscular/preperitoneal space, the patency or any leak from the side
of the glove nger should be checked by inating
with normal saline solution and aspiration.
Step 4 e balloon is pushed down into the extra-
peritoneal space (. Fig.34.3) just in front of the
symphysis and inated with about 300ml of saline
solution to create a space for safe introduction of a
12mm camera port later on. Aer aspiration of the
uid, the cannula is withdrawn and replaced by a
camera port with a 10mm optic (. Fig.34.4).
. Fig.34.4 Replacement of the balloon by a camera
port with a 10mm optic
. Fig.34.5 Suprapubic retromuscular plain
Step 5 Insuation of carbon dioxide into the
already preformed preperitoneal space. In order to
avoid loss of gas during this step, the previously
mentioned holding sutures at the entrance to the
rectus sheath are xed to the port.
Step 6 Aer a complete creation of the space
under direct visualization (. Fig.34.5), the 12mm
port may be safely inserted and will accommodate
the camera and will be used to introduce the mesh
aer a complete dissection of the retromuscular
space (. Fig.34.6).
Step 7 Removal of the 10mm port which had
been introduced through the wound at the umbilicus. Now, the opposite side of the posterior sheath
of the rectus muscle is also incised. ese incisions
of the posterior wall of the rectus sheath on both
sides are continued caudally and cranially as far as
368
R. Bittner and J. Schwarz
34
it is convenient in relation to the small skin incision. Note: e linea alba must be preserved; therefore, rst, the preperitoneal fat and the peritoneum
attached to the midline should be pushed down
before safe longitudinal incision of the posterior
rectus sheath is possible.
. Fig.34.6 The suprapubic camera trocar is placed
(arrow)
Step 8 Gentle blunt detachment of the posterior
sheath of the rectus muscle using the curved
sponge forceps as far as it is possible, which is very
easy to do.
Step 9 Provisionally tight closure of the skin inci-
sion. Introducing the 10mm optic (30°) via the
12mm port into the preperitoneal space proximal
to the symphysis (. Fig. 34.7). Insuation of the
carbon dioxide up to a pressure of 14mmHg.
Step 10 Endoscopic visualization of the retro-
muscular space with the surgeon standing between
the legs and the video tower behind the head of the
patient. Starting the endoscopic dissection
(reversed TEP) aer introducing a 5mm working
trocars on each side laterally to the midline in the
medio-clavicular line and about 3–5cm above of
the umbilicus under direct view (. Fig.34.8).
Continuation of the incision of the posterior
rectus sheath cranially up to the costal margin
and the xiphoid (. Fig.34.9). e space behind
the costal margin as well as behind the sternum
(fatty triangle) is easily dissected and opened for
later mesh placement. It is important to preserve
the linea alba (. Fig. 34.9). Complete blunt
detachment of the fascia from the rectus muscle
while carefully preserving the vessels and the
nerves perforating the fascia laterally.
. Fig.34.7 The skin incision at the umbilicus is
provisionally closed
. Fig.34.8 Placement of
the working trocars, later
followed by a second optic
trocar for precise dissection
of the suprapubic region.
a View from outside. b View
from inside
a
Step 11 Introducing a 5 or 10 mm optic trocar
about 5–7 cm superior to the working trocars
under view through the rectus muscle (. Fig.34.8).
Aerward, continuation of the incision of the posterior rectus sheath downward to the linea arcuata.
e space of Retzius will be opened and the dissection may be proceeded down to the pubic bone and
below of the 12mm trocar(
b
. Fig.34.10).
Endoscopic Mini/Less Open Sublay (EMILOS) Technique
. Fig.34.9 Dissection of the upper retromuscular space
is completed
369
. Fig.34.11 Suture of the posterior sheet of the rectus
muscle
34
Hernia defect
Suprapubic
optic trocar
Pelvis
. Fig.34.10 Dissection of the suprapubic region
Step 12 Aer completion of the dissection of the
retromuscular space, it is possible to suture the posterior sheet in patients who want an ideal reconstruction of the abdominal wall without any
bulging in the later course (. Fig.34.11).
Step 13 Preparation of a large mesh (20 × 30/40
cm, macroporous) prexed with 4–6 holding loops
placed in the middle of the upper and the lower rim
as well as laterally 1–2cm away from the border of
the mesh in order to facilitate subsequent
positioning of the mesh (. Fig.34.12). e holding
loop at the top of the mesh should be about 50cm
in length. e mesh is then formed from each side
as a double roll xed by three sutures.
Step 14 Introduction of the cephalad holding
loop via the lower 12mm trocar in direction of
. Fig.34.12 Placement of the holding loops
the sternum under view of the upper optic. e
loop is caught by a grasping needle introduced in
the angle between the xiphoid and the costal margin. e double-rolled mesh is then introduced
through the 12 mm trocar and pulled to the
retrosternal region.
Step 15 Aer cutting the xation sutures, the
mesh is unrolled and placed at within the retromuscular space with the help of the holding loops
(. Fig.34.13).
Two Redon drains are introduced via the
5mm working trocars, carbon dioxide is drained
o, and trocars and holding loops are removed.
Step 16 e skin is reopened, the wound lavaged
with an antiseptic solution, and the hernia defect is
closed with a nonabsorbable running suture in
small bite technique. e wound is closed and
dressed, and an abdominal binder is placed.
370
R. Bittner and J. Schwarz
. Fig.34.13 The mesh (20×30cm) is placed
34.3 Preliminary Results
Between June 2015 and September 2016, a
total of 33 patients were operated by EMILOS
technique. The indication for operation was in
19 patients with an umbilical/epigastric her-
nia in combination with a rectus diastasis and
in 14 patients with an incisional hernia. In 31
patients the size of the implanted mesh was
20 × 30cm, in 2 patients it was 16× 30 cm.
The results are shown in
. Table 34.1. No
intraoperative complications were observed.
2–4 days). Postoperatively two complications
were observed. One patient developed a small
superficial wound necrosis, which was excised;
the further course was uncomplicated. The sec-
ond patient suffered from a severely infected
seroma; therefore the mesh was removed
3weeks after the operation.
e postoperative pain score between the h
and seventh postoperative day was in rest below
VAS 3 and under physical stress 3.9 (range VAS
0–6).
e late cosmetic results are excellent
(. Fig.34.14).
34
. Table34.1 Biologic and treatment data
Operation Age (years) BMI Defect size
(cm2)
EMILOS n=33 57 (31–76) 30,1 (24,3–37,5) 30,1 (3–150) 5,25 (3–8) 157 (90–255)
Length of
incision (cm)
Operation time
(min)
. Fig.34.14 Cosmetic result 1 year after the operation
Endoscopic Mini/Less Open Sublay (EMILOS) Technique
371
34
34.4 Discussion
e ideal indications for this new operation technique are primary or secondary ventral hernias in
patients presenting an additional signicant rectus diastasis (. Fig.34.1a). In these patients, mid-
line prosthetic augmentation of the whole
abdominal wall is recommended as the rate of
recurrence is high in this group [9]. Early results
of the EMILOS technique in the therapy of primary and secondary ventral hernias are promising [6]. e impetus to develop novel minimally
invasive operative techniques which enables the
surgeon to get the mesh out of the abdominal cavity has been a new and exciting trend in hernia
surgery. e combination of the benets of the
open extraperitoneal and retromuscular repair
with the smaller incision and lower wound morbidity of laparo-endoscopic surgery provides the
primary benets of each of these repairs while
avoiding their limitations.
In 2004, Conze etal. [10] pointed out that the
incision of the posterior rectus sheath and the
opening of the “fatty triangle” is an important step
of open retromuscular mesh repair, which enables
the surgeon to position the mesh behind the
xiphoid and the costal margin for prevention of
recurrences. erefore the posterior lamina of the
rectus sheath in its upper part must be le open in
this technique. However, Reinpold etal. (7 Chap.
33
) did not close the posterior rectus sheath at all
in the vast majority of their MILOS cases.
According to his experience, the complete closure
of the posterior rectus sheath seems to be not necessary for the success of the operation. But, both
authors claimed the reconstruction of the linea
alba in open sublay repair respectively and the
preservation of the anterior sheath in MILOS
technique as indispensable steps of the repair. In
most of our EMILOS patients, we also didn’t
suture the posterior sheath accordingly, but in
some of these cases, we observed an unpleasant
bulging in the midline of the upper abdominal
wall. erefore, to prevent any bulging, in the last
seven cases, we sutured the middle and lower part
of the rectus sheath. Indeed, in the follow-up
regarding the shape of the abdominal wall, these
patients showed a better cosmetic result compared with the early cases.
e recent literature reports several techniques for reconstruction of the midline in
patients with rectus diastasis by suture plication
and mesh augmentation without performing a
large skin incision [11, 12]. e disadvantage of
one of these two studies is that the mesh is placed
in an unfavorable subcutaneous position [11];
the second study recommends that the mesh
should be pushed through the hernia defect into
the preperitoneal plane [12]; therefore, only
meshes with a limited size may be implanted.
Moreover, these procedures are complicated by a
high frequency of seroma formation [12]. Other
authors propagate the transabdominal route in
order to bring the mesh into the preperitoneal
retromuscular position [13, 14]. e disadvantages of these transabdominal techniques are as
follows: (1) enhanced risk for bowel lesion [13,
14], (2) technical diculties [13, 14], (3) use of
several linear cutters [14] which increases the
costs dramatically, (4) use of countless tacks [14]
which increases the risk for pain, and (5) limited
size of mesh [13, 14] which increases the risk for
recurrences. According to our experiences utilizing the EMILOS repair, these disadvantages are
avoided (6). e best current indications for
EMILOS are patients presenting with a primary
or secondary hernia in the midline and concurrent rectus diastasis. Each step of the EMILOS
operation is well standardized and improved for
routine clinical use.
34.5 Conclusion
In conclusion, both new techniques, MILOS and
EMILOS, are patient friendly, produce remarkable less acute and chronic pain, minimize the
amount of abdominal trauma, avoid traumatic
mesh xation or expensive mesh, and get the
mesh out of the abdominal cavity. Both techniques are standardized, reliable, and reproducible. Mini-open and videoendoscopic steps are
complementary and indispensable parts of the
MILOS concept. Future studies are necessary to
clarify which technique will be the best for the
specic hernia and individual patient.
References
1. Al Chalabi H, Larkin J, Mehigan B, McCormick P.A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta- analysis of
randomized controlled trials. Int J Surg. 2015;20:
65–74.
372
R. Bittner and J. Schwarz
2. Sauerland S, Walgenbach M, Habermalz B, Seiler CM,
Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane
Database Syst Rev. 2011;16(3):CD007781.
3. Arita NA, Nguyen MT, Nguyen DH, Berger RL, Lew DF,
Suliburk JT, Askenasy EP, Kao LS, Liang MK. Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias. Surg Endosc. 2015;29(7):
1769–80.
4. Awaiz A, Rahman F, Hossain MB, Yunus RM, Khan S,
Memon B, Memon MA.Meta-analysis and systematic
review of laparoscopic versus open mesh repair for
elective incisional hernia. Hernia. 2015;19(3):449–63.
5. Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli G,
Fortelny R, Köckerling F, Kukleta J, LeBlanc K, Lomanto
D, Misra M, Morales-Conde S, Ramshaw B, Reinpold W,
Rim S, Rohr M, Schrittwieser R, Simon T, Smietanski M,
Stechemesser B, Timoney M, Chowbey P.Guidelines for
laparoscopic treatment of ventral and incisional
abdominal wall hernias (international Endohernia society [IEHS])—part III.Surg Endosc. 2014;28(2):380–404.
6. Schwarz J, Reinpold W, Bittner R.Endoscopic mini/less
open sublay technique (EMILOS)—a new technique
for ventral hernia repair. Langenbeck's Arch Surg.
2017;402(1):173–180. doi: 10.1007/s00423-016-1522-0.
Epub 2016.
7. Chowbey PK, Khullar R, Sharma A, Soni V, Baijal
M.Totally extraperitoneal repair of inguinal hernia. J
Minim Access Surg. 2006;2(3):160–4.
8. Misra MC, Kumar S, Bansal VK.Total extraperitoneal
(TEP) mesh repair of inguinal hernia in the developing
world: comparison of low-cost indigenous balloon
dissection versus direct telescopic dissection: a prospective randomized controlled study. Surg Endosc.
2008;22(9):1947–58.
9. Köhler G, Luketina RR, Emmanuel K.Sutured repair of
primary small umbilical and epigastric hernias: concomitant rectus diastasis is a signicant risk factor for
recurrence. World J Surg. 2015;39(1):121–6.
10. Conze J, Prescher A, Klinge U, Saklak M, Schumpelick
V.Pitfalls in retromuscular mesh repair for incisional
hernia: the importance of the “fatty triangle”. Hernia.
2004;8(3):255–9.
11. Köckerling F, Botsinis MD, Rohde C, Reinpold W.Endoscopic-assisted linea alba reconstruction plus mesh
augmentationfortreatmentofumbilicaland/orepigastricherniasandrectus abdominis diastasis - early
results. Front Surg. 2016;3:1–6.
12. Bellido Luque J, Bellido Luque A, Valdivia J, Suarez
Gráu JM, Gomez Menchero J, García Moreno J, Guadalajara Jurado J.Totally endoscopic surgery on diastasis
recti associated with midline hernias. The advantages
of a minimally invasive approach. Prospective cohort
study. Hernia. 2015;19(3):493–501.
13. Schroeder AD, Debus ES, Schroeder M, Reinpold
WM.Laparoscopic transperitoneal sublay mesh repair:
a new technique for the cure of ventral and incisional
hernias. Surg Endosc. 2013;27(2):648–54.
14. Costa TN, Abdalla RZ, Santo MA, Tavares RRFM, Abdalla
BMZ, Cecconello I. Transabdominal midline reconstruction by minimally invasive surgery: technique
and results. Hernia. 2016;20(2):257–65.
34