Impact of Prenatal Repair for Fetal Myelomeningocele on Gastrointestinal Function

To assess the impact of postnatal, open fetal, and fetoscopic repairs for open neural tube defects (ONTDs) on bowel function and to assess the use of diet modification and medication use to achieve regular bowel function.

A retrospective cohort study was performed from 2011 to 2020 at our academic referral fetal center. Patients were stratified by route of surgery (postnatal, open prenatal, or fetoscopic prenatal). Bowel function was assessed by patient reported Bristol stool scale as well as a detailed review of current medication usage for bowel management. Patient demographics and clinically relevant outcomes were obtained from electronic medical records. The primary outcome was bowel function assessed at 30-month follow up visit.

A total of 150 patients with fetal ONTD underwent repair at our institution. Forty-eight (32%) underwent postnatal repair, 34 (23%) open fetal surgery, and 68 (45%) fetoscopic repair. Eighty-six patients (57%) reported abnormal bowel function at 30 months of life. No differences were noted in abnormal bowel function between surgical approaches (postnatal 35% vs open prenatal 26%, and fetoscopic 49%, P = .08). Patients who underwent postnatal repair were more likely to require oral regimens to achieve normal bowel function compared with either prenatal surgery approach (postnatal 83% vs open prenatal 59%, and fetoscopic 69%, P = .046).

Abnormal bowel function remains a significant morbidity regardless of surgical approach for ONTD. Fetal surgery (open or fetoscopic) for ONTD may result in equivalent bowel function when compared with postnatal repair.