Brazil doctors perform never-before-seen fetal surgery

An unprecedented procedure to correct the congenital malformation of a 33-week-old fetus was performed at the Hospital da Criança e Maternidade, in São José do Rio Preto, São Paulo state, in June. The fetus had gastroschisis—a hole in the abdomen that leads to organs, usually the intestines, developing outside—was operated on through fetoscopy. Up to this moment, the correction was only executed after birth.

The pioneering procedure was presented this week at the World Fetal Medicine Congress, in Alicante, Spain. In Brazil, one out of 2 thousand babies are born with this defect.

Doctors needed one hour and 40 minutes to do the procedure. The fetoscopy technique is similar to a laparoscopy. It is hardly invasive, as it is not an open surgery. Four small incisions are opened on the parent’s abdomen where instruments are introduced in a bid for health professionals to look into the womb and correct the malformation.

Progress after birth

Forty-eight hours after the surgery, even though both mother and fetus were well, part of the intestines was observed during an ultrasound to have come out through a small aperture, so the doctors chose the conventional treatment and fix the issue after the birth.

Doctor Gustavo Henrique de Oliveira explained that the suture was intact, but a small opening, measuring some three millimeters, next to the umbilical cord, made the intestinal folds come out again. “We were very careful during the surgery to make sure the suture wasn’t so close to the umbilical cord, as it could hinder the circulation in it,” he said.

Oliveira said the incident does not mean the procedure was unsuccessful, as labor transpired as expected, near the 34th week. Despite the problem, the doctors said, the baby was benefited after the birth. “It does seem the baby has making a little more progress, but I can’t give any more concrete information,” he said.

Time in hospital

“[The procedure after birth makes] babies take very long to be able to be fed. The intestines are often born half-paralyzed or very inflamed, and it takes a long time before they can be fed orally. They rely on parenteral nutrition and spend a lot of time in the ICU. Hospital stays averaged some 30 days after the traditional technique was performed,” Oliveira explained.

The technique will be perfected and the fetal surgery is expected to prove better than the conventional operation. Among its advantages is the fact that the operation is performed in the “most sterile possible” environment, still in the womb, bringing infection risks to a minimum. Another upside is the baby’s health after birth, as the infant may be discharged from hospital in two or three days and be breastfed normally. The mother will also be more likely to be with her baby from the first moments.

The surgery is not widely available. The operation “requires intensive technical training and infrastructure not found in every hospital. As is the case with any new technique, enhancements and more experience are still needed before it becomes widespread,” Oliveira said, adding that a number of medical teams with different backgrounds were mobilized for this surgery. The Hospital da Criança was selected because of its traditional gastroschisis surgery.