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Author Spotlight: Recent Advancements in Reoperative Foregut Surgery
Published on: September 22, 2023
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Complex gastroschisis: a new indication for fetal surgery?
L Joyeux1,2,3,4,5, M A Belfort5,6,7, P De Coppi1,2,3,8
1MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.
Summary
Gastroschisis (GS) is a congenital defect where bowels exit the abdomen. Fetoscopic repair may improve outcomes for complex cases by addressing fetal bowel damage before birth.
Area of Science:
- Fetal Medicine
- Neonatal Surgery
- Congenital Anomalies
Background:
- Gastroschisis (GS) involves congenital abdominal wall defects with bowel evisceration.
- Pathogenesis is hypothesized as a two-hit process: umbilical hernia rupture followed by secondary bowel injury.
- Complex GS, involving intestinal atresia or necrosis, leads to significant neonatal morbidity and mortality.
Purpose of the Study:
- To evaluate the potential for fetoscopic repair of complex gastroschisis.
- To assess the feasibility of antenatal management based on International Fetal Medicine and Surgery Society (IFMSS) criteria.
- To propose a research agenda for clinical implementation.
Main Methods:
- Review of natural history and prenatal diagnostic advancements.
- Assessment of fetoscopic surgery safety and efficacy in expert centers.
- Evaluation of criteria for fetal surgery eligibility.
Main Results:
- Fetoscopic repair may reduce fetal and neonatal complications associated with complex GS.
- Recent advances support reconsidering antenatal management for complex GS.
- IFMSS criteria may be applicable for selecting candidates for fetoscopic repair.
Conclusions:
- Fetoscopic repair is a promising approach for complex gastroschisis.
- Further research is needed to establish a pathway for clinical implementation.
- Antenatal intervention could potentially improve outcomes for affected neonates.
