Fetal Surgery for Gastroschisis—A Review with Emphasis on Minimally Invasive Procedures

Abstract

(1) Background: The morbidity of gastroschisis is defined by exposure of unprotected intestines to the amniotic fluid leading to inflammatory damage and consecutive intestinal dysmotility, the viscero-abdominal disproportion which results in an abdomen too small to incorporate the herniated and often swollen intestine, and by associated pathologies, such as in complex gastroschisis. To prevent intestinal damage and to provide for growth of the abdominal cavity, fetal interventions such as amnio exchange, gastroschisis repair or covering have been evaluated in several animal models and human trials. This review aims to evaluate the reported techniques for the fetal treatment of gastroschisis by focusing on minimally invasive procedures. (2) Methods: We conducted a systematic database search, quality assessment and analyzed relevant articles which evaluate or describe surgical techniques for the prenatal surgical management of gastroschisis in animal models or human application. (3) Results: Of 96 identified reports, 42 eligible studies were included. Fetal interventions for gastroschisis in humans are only reported for EXIT procedures and amnio exchange. In animal models, particularly in the fetal sheep model, several techniques of open or minimally invasive repair of gastroschisis or covering the intestine have been described, with fetoscopic covering being the most encouraging. (4) Discussion: Although some promising minimally invasive techniques have been demonstrated in human application and animal models, most of them are still associated with relevant fetal morbidity and mortality and barely appear to be currently applicable in humans. Further research on specific procedures, instruments and materials is needed before any human application.

Improved Mortality of Patients with Gastroschisis: A Historical Literature Review of Advances in Surgery and Critical Care from 1960–2020

“…Though potential predictive factors of complex gastroschisis have been identified with the use of prenatal imaging, refinement of prenatal evaluation of complex gastroschisis is still needed [ 32 , 37 ]. Furthermore, fetal surgery has also been more recently proposed, though further data and investigation is needed regarding this innovative intervention [ 38 , 39 ].…”

Minimally Invasive Bimanual Fetal Surgery—A Review

“…Realizing our suggested algorithm of firstly experimenting on inanimate objects, then advancing to deceased animals and subsequently to live animal models, in order to allow for the progression to human cases, would reduce the overall harm to the animals who are experimented on [ 5 ]. Logically, an animal mother should either only carry one fetus or, if not compatible with the hypothesized approach or proven impractical, carry more fetuses which consequently are to be utilized; none are to be discarded.…”

“…The literature search was performed according to the methods previously reported ( Figure 1 ) [ 5 ].…”

“…For quality assessment, data extraction, and statistical analysis, we used the same methods that have been reported previously [ 5 ].…”

Maternal and obstetric outcomes after Ex-Utero Intrapartum Treatment (EXIT): a single center experience

“…In recent years, EXIT indications have expanded to address a broader range of prenatal anomalies. It has been increasingly utilized for the correction of non-cardiorespiratory fetal pathologies such as selected cases of gastroschisis [ 14 – 16 ]. In such cases, EXIT procedure enables the complete repositioning and primary closure of the prolapsed bowel during the fetal stage, preventing bowel expansion following neonatal breathing.…”