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BACKGROUND: The incidence of direct inguinal hernia in the pediatric population is relatively low and is usually discovered intraoperatively, rendering it unfamiliar to most pediatric surgeons. The traditional approach involves directly addressing the peritoneal defect, which includes dissecting the sac and repairing the peritoneum, reinforced with the umbilical ligament. In this paper, we present our experience with a novel approach to anatomical repair utilizing a non-mesh transabdominal preperitoneal (TAPP) approach. METHODS: This a retrospective case series of direct inguinal hernia that were operated laparoscopically using the novel approach of repair from January 2018 to January 2024. Data were analyzed for demographics, presentation, type of defect, operative time, complications, and recurrence. The new approach utilizes the pre-peritoneal approach to delineate the exact facial defect then, primary anatomical repair is established using 2/0 non-absorbable braided sutures. Finally, closure of the peritoneum was performed using running 4/0 absorbable sutures. This is a retrospective case series of direct inguinal hernias that were operated on laparoscopically using the novel repair approach from January 2018 to January 2024. Data were analyzed for demographics, presentation, type of defect, operative time, complications, and recurrence. The new approach employs the pre-peritoneal approach to accurately delineate the fascial defect, followed by primary anatomical repair using 2/0 non-absorbable braided sutures. Finally, the peritoneum is closed using running 4/0 absorbable sutures. RESULTS: Data from nine cases were included. Six cases were on right side, and three cases were on left side. Patients were predominantly boys (8 boys and 1 girl). The mean age at operation was 25.1 months (range:11 month to 5 years). Four patients had previous indirect inguinal hernia repair on the same side. The mean operative time was 34 ± 9 min. No intraoperative complications occurred. The median follow up period was 24 months with no recurrence was detected in any of the cases. CONCLUSION: The non-mesh TAPP approach offers excellent exposure of the fascial structures, facilitating accurate identification and repair of the defect. Despite being technically demanding, it allows for the establishment of a robust anatomical repair. No recurrences occurred in the study group; however, a longer follow up and a larger sample are needed to provide more reliable evaluation. LEVEL OF EVIDENCE: III.
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Background: In neonates, percutaneous central venous catheter (CVC) insertion is often a challenging technique. Recent reports have reported the efficacy of ultrasound (US) guidance when performing such an intervention. We conducted this study to compare US-guided and minimal surgical CVC insertion regarding time and ease of insertion, reliability, and complications. Patients and Methods: This prospective randomized study included 92 neonates scheduled for CVC insertion. They were divided into two groups: Group A (46 neonates) underwent the US-guided approach and Group B (46 neonates) underwent the surgical approach. The number of attempts and the duration of the procedure were documented in both groups. In addition, intraoperative and postoperative complications were recorded. Results: Each of patient's age, gender, weight, and the indication of catheter insertion were statistically comparable between the two groups. The number of trials showed a significant increase in Group A (1.52 vs. 1.07 in Group Bp <0.001). Nevertheless, the time of the procedure was significantly decreased in the same group (3.68 vs. 10.21 in Group Bp <0.001). Table 2 summarizes the previous findings. Failure was encountered only in one case in Group A (2.2%), which was converted to the open surgical technique. In general, the incidence of complications showed no significant difference between the two approaches. Conclusion: Although US-guided CVC insertion is associated with an increased number of trials, the duration of the procedure is significantly diminished with its use. Furthermore, it has a high success rate in addition to a comparable complication profile with the traditional surgical method.