Cristián Grillo Marín

Background Minimally invasive techniques are widely used to treat abdominal wall defects. This study describes a cranial approach for performing the total preperitoneal/pretransversalis enhanced-view totally extraperitoneal (PeTEP) technique and presents early outcomes for treating primary ventral hernias (PVH), midline trocar site incisional hernias (IHs), both associated with rectus diastasis, as well as lateral IHs. Methods An observational study was conducted from October 2023 to September 2024, identifying cases where the cranial PeTEP technique was employed, using data from a multicentric prospectively maintained database. The cranial approach involved dissection of the preperitoneal fatty rhomboid, extending the dissection across the preperitoneal and transversalis fascial plane to the semilunar lines laterally and the pubis caudally. For lateral defects, the dissection extended beyond the ipsilateral semilunar line, surpassing the lateral edge of the defect. Results Twenty-four patients underwent elective endoscopic hernia repair: 62.5% PVH, 29.2% midline IH, and 8.3% lateral IH. The mean defect area was 6.32 ± 6.13 cm², and the average mesh size was 497.21.41 ± 202.71 cm². The surgical site occurrences rate was 8.3%, with no surgical site infections or recurrences at a mean follow-up of 5.3 months. Conclusions The cranial PeTEP technique was a safe, effective, and reproducible method for repairing PVH and small-medium IHs associated with rectus diastasis in a selected cohort of patients. It facilitated large preperitoneal mesh placement without entering the retromuscular plane and avoided posterior component separation in lateral defects. Larger studies with extended follow-up are needed to confirm these promising results. Graphical Abstract

Background: Cisplatin is employed in hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for peritoneal surface malignancies (PSMs). The main concern regarding intraperitoneal cisplatin administration is nephrotoxicity. Numerous reports in this context are available. Our objective was to conduct a systematic review and meta-analysis to assess cisplatin-based HIPEC-related nephrotoxicity (CHRN). Methods: A systematic literature review on CHRN after CRS for the treatment of PSMs was performed. The literature search was carried out using Medline, Cochrane, and Embase. The last day of the search was 23 October 2023. PRISMA guidelines were used. A meta-analysis was then conducted. The main endpoint was the incidence of acute and chronic renal impairment after CHRN. Secondary endpoints included the potential impact of several clinical variables on the primary endpoint and a critical appraisal of the different renal impairment scales employed. Results: Our study included 26 articles with a total sample of 1473 patients. The incidence of acute kidney injury (AKI) was 18.6% (95% CI: 13.6–25%, range of true effects 3–59%). For chronic kidney disease, it was 7% (95% CI: 3–15.3%, range of true effects 1–53%). The variables that statistically influenced these results were the scale used to measure renal insufficiency, the use of nephroprotective agents, and the presence of pre-existing renal disease. Conclusions: The reported incidence of renal impairment following cisplatin-based HIPEC is highly variable. The incidence of renal failure obtained in this meta-analysis should be used as a reference for subsequent reports on this topic. Further prospective studies are warranted to establish optimal and standardized management.