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Prenatal coverage of experimental gastroschisis with a collagen scaffold to protect the bowel
Luc A J Roelofs1, Paul J Geutjes, Christina A Hulsbergen-van de Kaa
1Department of Urology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. L.Roelofs@uro.umcn.nl
Insights
A collagen scaffold protected fetal lambs' bowels in a gastroschisis model, promoting tissue regeneration and potentially improving outcomes for this congenital anomaly.
Area of Science:
- Fetal surgery
- Regenerative medicine
- Congenital defect repair
Background:
- Gastroschisis involves bowel damage from amniotic fluid toxins and abdominal wall constriction.
- Current treatments face challenges in protecting the exposed fetal bowel.
Purpose of the Study:
- To evaluate a collagen scaffold for protecting the eviscerated bowel in fetal gastroschisis.
- To assess scaffold-induced tissue regeneration for abdominal wall reconstruction.
Main Methods:
- Surgically created gastroschisis in 12 fetal lambs at 79 days gestation.
- Applied a dual-layer type I collagen scaffold around the abdominal wall defect.
- Examined lambs at 140 days gestation via caesarean section.
Main Results:
- 67% survival rate; 7 of 8 survivors had bowel coverage.
- Scaffold replacement by connective and skin tissues observed.
- Bowel repositioned in the abdominal cavity in 5 lambs, with minimal adhesions.
Conclusions:
- Prenatal collagen scaffold application is feasible in experimental gastroschisis.
- The scaffold significantly reduced bowel wall damage.
- This technique shows promise for treating fetuses with gastroschisis.
Background/Purpose:
In fetuses with gastroschisis, toxic products in the amniotic fluid and constriction at the defect of the abdominal wall are considered causative of damage to the eviscerated bowel. The aim of this study was to cover the eviscerated bowel in gastroschisis with a collagen scaffold to protect the bowel and induce cell growth into the scaffold, which could lead to skin or abdominal wall formation replacing the scaffold.
Methods:
In 12 fetal lambs gastroschisis was surgically created at 79 days gestation. A dual-layer type I collagen scaffold was sutured into the skin of the abdominal wall around the defect covering the eviscerated bowel. Lambs were examined after caesarean section at 140 days' gestation.
Results:
Survival was 67%. In 7 of 8 surviving lambs the bowel was found to be covered after birth. One scaffold had ruptured. The bowel was found repositioned in the abdominal cavity in 5 lambs. In 2 lambs it was still partially outside. Only minor adherence of bowel loops and no fibrous peel formation were seen. Connective tissue and skin tissue replaced the scaffold.
Conclusions:
Prenatal coverage of the bowel in experimental gastroschisis with a collagen scaffold is feasible in fetal lambs, significantly diminished damage to the bowel wall, and skin and connective tissue replaced the scaffold. This technique may be promising in the care of fetuses with this congenital anomaly.
