“微小切口开放sublay（MILOS）概念”在腹壁疝修补中的应用进展

Application of ＂MILOS concept＂ in ventral hernia repair

腹壁疝的主要手术方法是直接缝合结合补片加强修补，放置补片的最佳位置是肌后间隙（即sublay）。常见手术方式有开放sublay补片修补和腹腔镜腹腔内补片修补（IPOM）。但开放sublay手术创伤较大，切口并发症发生率高；而腹腔镜IPOM的肠管损伤、补片相关并发症和术后疼痛等风险较高。结合上述两种术式的优点，德国专家Reinpold首先提出了＂微小切口开放sublay（MILOS）概念＂，利用微小的手术切口结合腹腔镜技术，完成微创sublay修补。MILOS手术适用范围较广，几乎适用于所有原发性或复发性腹壁疝，其中白线疝、中线切口疝和脐疝为最佳适应证。MILOS手术具有手术创伤小、术后并发症少、复发率低和经济效益比高等优点。在＂MILOS概念＂的基础上手术可进一步改良扩展，根据需要转为腹腔镜手术（EMILOS、eTEP）或机器人手术。MILOS手术这个最新的腹壁疝微创修补方式正逐渐被世界范围的外科医生所接受，并应用于腹壁疝的临床治疗中。目前已有多篇文献报道了MILOS手术的疗效，证实了其进一步推广应用的价值。

Direct suture repair with mesh reinforcement is the main surgical procedure in ventral hernia repair. The best place for mesh implantation is retromuscular space which means sublay. The most commonly used techniques are open sublay and laparoseopic IPOM repair. But open sublay repair may cause more trauma to the abdominal wall and result in more infections. Laparoscopic IPOM repair carries an increased risk in bowel injury, mesh-related complications and postoperative pain. Germany surgeon Reinpold developed a new technique defined as ＂MILOS concept＂ by combining the advantages of open sublay and laparoscopic IPOM repair. This technique uses mini or less incision hybrid with endoscopic technique to accomplish minimally invasive sublay repair. The MILOS operation has the advantages of less operative trauma, fewer postoperative complications, low recurrence rate and high economic efficiency. ＂MILOS concept＂ has been applied with several modifications by using endoscopic technique （EMILOS and eTEP） or robotic surgery. This new minimal invasive ventral hernia repair technique is accepted and applied in clinical practice by most surgeons worldwide. Several literatures already reported that this procedure had very good surgical outcomes, and confirmed its value in further popularization.