1. Skin incision 2 to max. 5 cm via hernial orifice (Fig. A).
2. Display of hernial defect and preparation of the hernia sac.
3. Optional: minimal opening of the hernia sac allowing for manual probing, followed by open or laparoscopic adhesiolysis.
4. The peritoneum is freed up approx. 2 cm from the linea alba in a circular pattern and the posterior layer of the rectus muscle is freed.
5. The posterior layer of the rectus muscle is opened laterally on both sides (instrument: EndoTORCH ) (Fig. B) about 1 cm from the medial border of the rectus muscle (Fig. C).
6. Using long slim retractors and under endoscopic monitoring, the posterior layer of the rectus sheath is freed laparoscopically from the rectus muscle. In the midline endoscopically assisted dissection is performed in the preperitoneal plane: The peritoneum is freed up from the linea alba.
7. The further totally extraperitoneal preparation is performed through the hernia, either under direct vision with laparoscopic instruments or with endoscopic assistance.
8. The posterior layer of the rectus sheath generally remains open with a completely closed midline peritoneum.
9. Placement and spreading of the DynaMesh^®-CICAT mesh implant in the extraperitoneal cavity as a double roll and without skin contact.
10. Closure of the hernia defect over the mesh implant under minimal tension (Fig. D).11. Fixation of the DynaMesh^®-CICAT me
11. Fixation of the DynaMesh^®-CICAT mesh implant is only required if the hernia defect cannot be completely closed and there is bridging of the hernia defect.

more Information: https://milos-hernia-repair.com

Animation and video of entire procedure:

(en) – Animation & Operation:
MILOS OPERATION with DynaMesh^®-CICAT (Dr. Reinpold)

Optimal handling

• The special anti-slip surface of the DynaMesh^®-CICAT ensures the mesh stays in position and enables optimal handling.
• DynaMesh^®-CICAT is marked with green lines, which indicate the required orientation (cranio-caudal)
• The light tube for the MILOS technique (Mini Less Open Sublay technique) was developed with Mr Wolfgang Reinpold, consultant at the Wilhelmsburger Groß-Sand Hospital, Hamburg, specially for laparoscopic-assisted treatment of abdominal wall hernias.

1. Semi-circular infraumbilical skin incision
2. The hernia sac or base of navel is dissected and encircled with a tape (Fig.2)
3. Detachment of base of navel approx. 1 cm above the fascia by circular division of the hernia sac (Fig.3) – ATTENTION: Check contents of hernia sac
4. Circular dissection of the peritoneum from the fascia (Fig.4)
5. Closure of the peritoneum with continuous absorbable suture
6. Adequate dissection of the preperitoneal cavity in all directions (Fig. 6)
7. Digital check of the preperitoneal cavity
8. Insertion and positioning of mesh on the peritoneum (subfascia) (Fig. 8)
9. Digital check that the mesh position is fold-free
10. Closure of the midline with continuous absorbable suture
11. Fixation of the base of the navel to the fascia with absorbable interrupted suture
12. Skin closure with absorbable interrupted sutures subcutaneously and intracutaneously
13. Wound closure with steristrips

Animation and video of entire procedur:

(en) Animation & Operation:
Umbilical hernia in PUMP technique (Dr. Volmer)