Prenatal surgery for congenital diaphragmatic hernia
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Updated: Aug 30, 2026
Transuterine Fetal Tracheal Occlusion Model in Mice
Published on: February 5, 2021
Jeff Ying-Kit Au-Yeung1, Kwong-Leung Chan
1Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
Insights
Congenital diaphragmatic hernia (CDH) treatment has improved with Fetendo-PLUG, a minimally invasive fetal tracheal occlusion technique. This method offers a 75% survival rate, reducing complications for both mother and fetus.
Area of Science:
- Medical Science
- Surgical Innovation
- Fetal Medicine
Background:
- Congenital diaphragmatic hernia (CDH) presents a high mortality rate, up to 77%, even with advanced care.
- Poor prognostic indicators include liver herniation, low lung-to-head ratio, and diagnosis before 24 weeks gestation.
- Current in utero open repair strategies have not improved survival rates.
Purpose of the Study:
- To evaluate the efficacy and safety of Fetendo-PLUG, a minimally invasive fetal tracheal occlusion technique for CDH.
- To compare Fetendo-PLUG outcomes with standard postnatal care and open hysterotomy fetal tracheal occlusion.
- To explore advancements in fetal surgical instrumentation for CDH management.
Main Methods:
- Development of Fetendo-PLUG: a video-fetoscopic intrauterine technique for tracheal occlusion.
- Refinement using a detachable balloon via a single 5 mm port under ultrasound guidance.
- Comparison of outcomes between Fetendo-PLUG, standard care, and open hysterotomy procedures.
Main Results:
- Fetendo-PLUG demonstrated a significantly higher survival rate of 75% compared to other methods.
- This technique resulted in fewer fetal and maternal complications.
- Minimally invasive approach reduced risks of recurrent laryngeal nerve injury and vocal cord paresis.
Conclusions:
- Fetendo-PLUG represents a promising advancement in managing congenital diaphragmatic hernia.
- Minimally invasive fetal tracheal occlusion offers improved survival and reduced complications.
- Further research is needed to refine fetal instrumentation and develop better tocolytic drugs.
Abstract:
Congenital diaphragmatic hernia (CDH) has a mortality rate of up to 77% despite optimal pre- and postnatal care. Fetuses with liver herniation, a low lung-to-head ratio, and an early diagnosis before 24 weeks have a particularly poor prognosis. In utero open repair of these fetuses does not improve patient survival. The PLUG (Plug the Lung Until it Grows) technique was reported to be able to reverse pulmonary hypoplasia in CDH. A foam plug or a titanium clip is used and the trachea can be unplugged using Ex Utero Intrapartum Tracheoplasty (EXIT) at birth. Since hysterotomy causes premature labour, a video-fetoscopic intrauterine technique of tracheal occlusion called Fetendo-PLUG was developed. Compared to those who receive standard postnatal care or fetal tracheal occlusion via open hysterotomy, patients who undergo Fetendo-PLUG are reported to have a higher survival rate of 75% and fewer fetal and maternal complications. A recent refinement is to use a detachable balloon for intratracheal occlusion through a single 5 mm port under real-time ultrasound guidance. Without the need for neck dissection, injury to the recurrent laryngeal nerves and trachea and vocal cord paresis can be minimized. The result of this form of treatment for CDH is promising, but further refinement of fetal instrumentation and development of effective tocolytic drugs are still required.
