V-021 MIDLINE RESTORATION VIA EMILOS TECHNIQUE

Abstract

Abstract Aim In recent years, numerous minimally invasive techniques have been developed for the repair of midline hernias associated with diastasis recti. The eMILOS technique (Endoscopic mini/less open sublay technique) allows midline repair with mesh placement in the retromuscular space through a small trans-hernial incision without entering the abdominal cavity. Material & Methods We present a case of a 45 year-old male who complained of umbilical bulge and pain. On physical exam, an umbilical hernia measuring 2cm was observed, associated with 5cm diastasis recti. Midline restoration via eMILOS approach was decided. In this technique, a transhernial endoscopic approach is performed with two 5mm ports on both flanks, allowing a complete dissection of the retromuscular space. First, a sublay approach of the umbilical hernia is performed. The hernial content is reduced and the posterior sheath is closed. Then, we place a homemade device (consisting of a wound protector, a surgical glove and a port) to perform the endoscopic approach. When the retromuscular space is completely dissected, both anterior and posterior sheaths are closed with barbed sutures. A large heavy polypropylene mesh is placed and fixed with absorvable tackers and glue. Afterwards, the endoscopic step is over and the ports are taked out, the umbilical fascia is closed with a running suture and the umbilicus scar is fixed. Results The patient presented a favorable evolution, with no recurrence a year postoperatively. Conclusions The eMILOS technique is a safe and effective alternative for the treatment of diastasis recti associated with midline defects.