Fetal surgery for congenital diaphragmatic hernia in the post-TOTAL trial era

Today, prenatal therapy for congenital diaphragmatic hernia (CDH) primarily centers on fetoscopic endoluminal tracheal occlusion (FETO). This procedure involves the temporary occlusion of the fetal trachea to promote lung development. The TOTAL (Tracheal Occlusion to Accelerate Lung Growth) trial demonstrated a significant improvement in survival rates for fetuses with severe CDH following FETO. The outcomes of the TOTAL trial have sparked heightened interest in the FETO procedure, leading to the publication of numerous additional studies. Nevertheless, subsequent research has yielded inconsistent results outside of randomized controlled trials. This review examines the variations in patient selection, procedural techniques, and postnatal care that may contribute to this variability while also exploring potential future directions for the FETO procedure and prenatal therapy for CDH.