OC08.08: Effects of complete and incomplete Solomon technique on perinatal outcomes in fetoscopic laser surgery

Abstract

Objectives:The Solomon technique has been suggested to reduce post-operative complications and thus improve twin survival following fetoscopic laser coagulation of chorionic vessels for Twin-twin transfusion syndrome (TTTS). We aimed to evaluate the benefit of this technique on perinatal outcome compared to selective ablation of anastomoses. Methods: We conducted a monocentric retrospective study comparing selective laser coagulation to coagulation of the vascular equator, from April 1999 to august 2020. To evaluate the impact of the technique on perinatal outcome, we used a propensity score matching based on gestational age at laser therapy, placenta localisation and Quintero stage. Results: A total of 798 pregnancies were included in the analysis. Compared with selective ablation, Solomon technique was associated with higher survival rates at discharge (Overall fetal survival of 70 % vs 79%, p < 0.001 at delivery, and of 66% vs 75%, p < 0.001 at discharge), higher double twin survival (49% vs 65%, p < 0.001), and fewer in utero fetal death (18% vs 12%, p < 0.001). We observed a reduction in post-operative complications such as TAPS (11% vs 4%, p < 0.001) and recurrences (7.9% vs 2.5%, p = 0.003), leading to fewer rescue secondary surgeries (18% vs 7.3%, p < 0.001) and less cord occlusions for neurological damage (8.3% vs 3%, p = 0.002). However, the Solomon technique was associated with an increasing risk of PROM, especially in early gestational age (3.3% vs 11%, p < 0.001 for PROM<24 weeks). Among the survivors at delivery, both groups had similar gestational age at birth. However, the Solomon group was associated with an increasing risk of acute respiratory distress (12% vs 29%, p < 0.001) and of bronchopulmonary dysplasia (3.2% vs 12%, p < 0.001). Neonatal mortality was similar in both groups. Conclusions: Although the risk of PPROM has increased, the introduction of the Solomon technique has significantly improved the perinatal outcome in pregnancies affected with TTTS.