The endoscopic-assisted or endoscopic mini- or less-open preperitoneal (E/MILOP) approach for primary and incisional ventral hernia repair.

Introduction: The endoscopic-assisted or endoscopic mini- or less-open sublay (E/MILOS) concept describes a contemporary approach of trans-hernial repair of ventral hernia via sublay mesh placement. The term sublay often causes confusion, and preperitoneal placement of mesh should be considered as a distinctive approach. We hereby present our experience of a novel approach, the E/MILOP approach, for the repair of primary and incisional ventral hernias.

Methods: All patients who underwent E/MILOP between January 2020 and December 2022 were identified and their preoperative and perioperative characteristics, as well as postoperative outcomes, were retrospectively analyzed. The surgical procedure entailed an incision over the hernia defect and careful entrance into, and development of, the preperitoneal space trans-hernially. A synthetic mesh was placed in the preperitoneal space and the defect was closed with sutures.

Results: A total of 26 patients with primary and/or incisional ventral hernias who underwent E/MILOP were identified. Three patients (11.5%) presented with two coexistent types of hernias, and out of a total of 29 hernias, there were 21 (72.4%) umbilical, four epigastric (13.8%) and four incisional (13.8%) hernias. The mean defect width was 2.7 ± 0.9 cm. All cases utilized a mesh with a mean mesh-to-defect ratio of 12.9. The mean postoperative stay was 1.9 days. Surgical site occurrence was observed in eight (30.1%) patients, but none required intervention. No recurrence was observed during a mean follow-up period of 286.7 days.

Conclusion: The E/MILOP approach is a novel alternative for primary and incisional ventral hernia repair.