Is there a therapeutic role for fetoscopic surgery in the prenatal treatment of gastroschisis? A feasibility study in sheep

Abstract

Minimally invasive fetoscopic enlargement of the defect within the abdominal wall is feasible in sheep fetuses with iatrogenic laparoschisis. This approach might benefit human fetuses with gastroschisis considered at high risk for bowel loss by constriction at the defect site. In contrast, return of herniated abdominal viscera followed by abdominal closure is limited by physiological constraints and seems currently not feasible with current fetoscopic instrumentation.

Fetoscopic management of gastroschisis in a lamb model

“…We were able to create gastroschisis by fetoscopy and perform a second fetoscopy 30 days later for assessment of the defect and the protruded intestine as well as fetoscopic management options with acceptable morbidity and mortality in eight sheep, which was similar to other reports [3,4].…”

“…Amniotic membranes were noted as the main obstacle during attempted second fetoscopy by another group [3]. Using amnioinfusion instead of air insufflation we were able to push the membranes against the uterine wall to facilitate fetoscopy.…”

“…Open surgical management of gastroschisis showed regression of the inflammatory peel after reducing the intestine into the abdominal cavity in a lamb model, but fetoscopic management of gastroschisis appeared technically unfavorable [3,4,12]. Our study demonstrated the in principal feasibility of fetoscopic management of gastroschisis, which may in the future be applied in human cases, as uterotomy appears unfavorable [13,14].…”

“…Any abdominal incision to the right of the umbilicus results in damage of the umbilical vein. It is interesting to note that another group created the defect in the left lower quadrant as well, although they did not mention the reason why [3]. We have to admit that the incision does not reflect the position of the defect in human pathology.…”

Was muss der (Viszeral-)Chirurg von der Kinderchirurgie wissen – kinderchirurgische Aspekte in der (Viszeral-)Chirurgie

“…Wichtig ist das Absuchen des Darmes nach Atresien [110], es liegt fast immer eine Drehungsanomalie vor. Der Wert von Überlegun-gen zur fetoskopischen Chirurgie [111] scheint anhand der aktuellen Ergebnisse abzunehmen. Im Langzeitverlauf ist neben den möglichen Verwachsungsbeschwerden auch immer an die Unklarheit der Zökumlage zu denken, d. h. besonders bei der Appendizitis sind untypische Symptome möglich.…”