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Laparoscopic Ventral Hernia Repair
            to the high cost of composite mesh used in IPOM vs a traditional   Medical talc increases the incidence of seroma formation following
            cheap one used in the TARM approach.                    onlay repair of major abdominal wall hernias. Parameswaran R,
                                                                    Hornby ST Hornby, Kingsnorth AN. DOI: 10.1007/s10029-013-1097-4.
                                                                    Hernia 2013;17(4):457–458. DOI: 10.1007/s10029-013-1116-5.
            lIMItAtIons                                           7.  Amirlak B, Mittal SK, Fitzgibbons RJ. Hernia repair. In: Zinner MJ and
            Transabdominal retromuscular is a feasible procedure for midline   Ashley SW, editors. Maingot’s Abdominal Operations, 11th edition.
            ventral hernias. We found that the best approach for epigastric   New York: McGraw-Hill Medical, 2007, pp.1125–1150.
            hernias is a three-port suprapubic approach, in lateral three-port     8.  Rucinski J, Margolis M, Panagopoulos G. Closure of the abdominal
            placement, we found it ergonomically difficult to suture midline   midline fascia: meta-analysis delineates the optimal technique. Am
                                                                    Surg 2011;67(5):421–426. PMID: 11379640.
            defects in the epigastric region. There was no difficulty in suturing     9.  Rettenbacher T, Hollerweger A, Macheiner P. Abdominal wall
            defects in umbilical and infraumbilical regions by the lateral   hernias: cross-sectional imaging signs of incarceration determined
            approach. Subxiphoidal port placement is also recommended for   with sonography. AJR Am J Roentgenol 2010;177(5):1061–1066. DOI:
            an umbilical and infraumbilical hernia.                 10.2214/ajr.177.5.1771061.
               Difficulties we encountered with this approach were in     10.  Bennett DH, Kingnorth AN. Hernias, umbilicus and abdominal wall.
            suturing anterior defects because of interference by breast tissue   In: Williams NS, Bulstrode CJK, O’Connell, editors. Bailey and Love’s
            in female patients and by a costal margin in male patients which   Short Practice of Surgery, 26th edition. Boca Raton, FL: CRC Press,
            interfered to some extent with hand movements. There was also   2013, pp.1272–1293.
            the problem access because of the falciform ligament in 10-mm     11.  Eknoyan G. Adolphe Quetelet (1796–1874): the average man and
                                                                    indices of obesity. Nephrol Dial Transplant. 23 (1): 47–51. DOI: 10.1093/
            port subxiphoidal access. Therefore, we gained initial access by   ndt/gfm517.
            5-mm port with 5-mm telescope in the left subcostal region after     12.  Farquharson M, Moren B. Farquharson’s Textbook of Operative
            pneumoperitoneum by a Veress needle. We then dissected down   General Surgery, 9th edition. India: Edward Arnold, 2005, pp. 519–527.
            the falciform ligament distally to proximally and then inserted     13.  Kuo EY, Klingensmith ME. General and perioperative care of the
            10-mm subxiphoidal port under vision.                   surgical patient. In: Klingensmith ME, Chen LE, Glasgow SC et al.,
               Of all these approaches, we found the suprapubic approach   editors. The Washington Manual of Surgery, 5th edition. Philadelphia,
            versatile for epigastric hernias and the lateral approach for   USA: Lippincott, Williams & Wilkins, 2008, pp.1–29.
            umbilical and infraumbilical hernias. The subxiphoidal approach     14.  Cooper Z, Kelly E. Preoperative and postoperative management. In:
                                                                    Zinner MJ, Ashley SW, editors. Maingot’s Abdominal Operations, 11th
            is ergonomically difficult in our experience. Further studies are   edition. McGraw-Hill Medical, NewYork, 2007, pp.9–35.
            needed to establish this procedure as the preferred method for     15.  Poelman MM. Modified onlay technique for the repair of the more
            the treatment of ventral hernias.                       complicated incisional hernias: single-centre evaluation of a large
               The medium-sized hernias (≤60 mm) only were included and it   cohort. Hernia 2010;14(4):369–374. DOI: 10.1007/s10029-010-0646-3.
            should be extended to include larger sized hernias.    16.  LeBlanc KA, William VB. Laparoscopic repair of incisional abdominal
                                                                    hernias using expanded polytetrafluoroethylene: preliminary
                                                                    findings. Surg Laparosc Endosc 1993;3:39–41. PMID: 8258069.
            conclusIon                                           17.  Tsimoyiannis EC. Seroma and recurrence in laparoscopic ventral
            Laparoscopic hernia repair either IPOM or TARM repair techniques   hernioplasty. JSLS 2008;12(1):51–57. PMID: 18402739.
            had less postoperative pain, shorter hospital stay, faster return to     18.  Amid PK, Graham M, Selwyn CA. Abdominal hernia: emerging trends
            normal daily activity, a lower rate of postoperative complications as   in diagnosis and management. Patient Care 2005;39:43. Gale
            regard wound infection and ileus, and better cosmetic appearance.   Academic  OneFile,  https://go.gale.com/ps/i.do?p=AONE&u=
                                                                    an o n ~59 919 d9 c & i d = G ALE|A133302223& v =2 .1& i t= r&
            However, we found that TARM repair technique was more time   sid=googleScholar&asid=bcd18bd0.
            consuming in comparison to the IPOM technique, but early results     19.  Hussain D, Sarfraz Sh, Kasmani J, et al. Laparoscopic repair of ventral
            indicated that TARM could be performed as a cheaper alternative   hernia. Journal of the College of Physicians and Surgeons Pakistan
            to IPOM mesh repair.                                    2012;22(11):683–685. PMID: 23146845.
                                                                 20.  Ramshaw B , Bachman SH. Laparoscopic Incisional and Ventral Hernia
                                                                    Repair. In: Soper NJ, Swanstrom LL, Eubanks WS editors. Mastery of
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