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Case Report: Fetoscopic Laparoschisis (FETO-LAP)—A New Therapeutic Route to Explore for Fetuses with Severe Diaphragmatic Hernias

Background: The purpose of this report is to describe the seminal case of a near-term human fetus with a life-threatening left diaphragmatic hernia that underwent fetoscopic tracheal occlusion (FETO) combined with fetoscopic partial removal of herniated bowel from the fetal chest by fetoscopic lapar...

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Autores principales: Kohl, Thomas, Riehle, Nadja, Messroghli, Leila, Maus, Sibylle, Otto, Christiane, Klinke, Michaela, Martel, Richard, Beck, Grietje, Boettcher, Michael, Schaible, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10670710/
https://www.ncbi.nlm.nih.gov/pubmed/38002849
http://dx.doi.org/10.3390/children10111758
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author Kohl, Thomas
Riehle, Nadja
Messroghli, Leila
Maus, Sibylle
Otto, Christiane
Klinke, Michaela
Martel, Richard
Beck, Grietje
Boettcher, Michael
Schaible, Thomas
author_facet Kohl, Thomas
Riehle, Nadja
Messroghli, Leila
Maus, Sibylle
Otto, Christiane
Klinke, Michaela
Martel, Richard
Beck, Grietje
Boettcher, Michael
Schaible, Thomas
author_sort Kohl, Thomas
collection PubMed
description Background: The purpose of this report is to describe the seminal case of a near-term human fetus with a life-threatening left diaphragmatic hernia that underwent fetoscopic tracheal occlusion (FETO) combined with fetoscopic partial removal of herniated bowel from the fetal chest by fetoscopic laparoschisis (FETO-LAP). Case summary: A life-threatening left diaphragmatic hernia (liver-up; o/e LHR of ≤25%; MRI lung volume ≤ 20%) was observed in a human fetus at 34 weeks of gestation. After counselling the mother about the high risks of postnatal demise if left untreated, the expected limitations of fetoscopic tracheal occlusion (FETO), and the previously untested option of combining FETO with fetoscopic laparoschisis, i.e., partial removal of the herniated bowel from the fetal chest (FETO-LAP), she consented to the latter novel treatment approach. FETO-LAP was performed at 36 + 5 weeks of gestation under general maternofetal anesthesia. Mother and fetus tolerated the procedure well. The neonate was delivered and the balloon removed on placental support at 37 + 2 weeks of gestation. On ECMO, a rapid increase in tidal volume was seen over the next eight days. Unfortunately, after this period, blood clots obstructed the ECMO circuit and the neonate passed away. Discussion: This seminal case shows that in a fetus with severe left diaphragmatic hernia, partial removal of the herniated organs from the fetal chest is not only possible by minimally invasive fetoscopic techniques but also well tolerated. As the effect of FETO alone is limited in saving severely affected fetuses, combining FETO with fetoscopic laparoschisis (FETO-LAP) offers a new therapeutic route with multiple, potentially life-saving implications.
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spelling pubmed-106707102023-10-30 Case Report: Fetoscopic Laparoschisis (FETO-LAP)—A New Therapeutic Route to Explore for Fetuses with Severe Diaphragmatic Hernias Kohl, Thomas Riehle, Nadja Messroghli, Leila Maus, Sibylle Otto, Christiane Klinke, Michaela Martel, Richard Beck, Grietje Boettcher, Michael Schaible, Thomas Children (Basel) Case Report Background: The purpose of this report is to describe the seminal case of a near-term human fetus with a life-threatening left diaphragmatic hernia that underwent fetoscopic tracheal occlusion (FETO) combined with fetoscopic partial removal of herniated bowel from the fetal chest by fetoscopic laparoschisis (FETO-LAP). Case summary: A life-threatening left diaphragmatic hernia (liver-up; o/e LHR of ≤25%; MRI lung volume ≤ 20%) was observed in a human fetus at 34 weeks of gestation. After counselling the mother about the high risks of postnatal demise if left untreated, the expected limitations of fetoscopic tracheal occlusion (FETO), and the previously untested option of combining FETO with fetoscopic laparoschisis, i.e., partial removal of the herniated bowel from the fetal chest (FETO-LAP), she consented to the latter novel treatment approach. FETO-LAP was performed at 36 + 5 weeks of gestation under general maternofetal anesthesia. Mother and fetus tolerated the procedure well. The neonate was delivered and the balloon removed on placental support at 37 + 2 weeks of gestation. On ECMO, a rapid increase in tidal volume was seen over the next eight days. Unfortunately, after this period, blood clots obstructed the ECMO circuit and the neonate passed away. Discussion: This seminal case shows that in a fetus with severe left diaphragmatic hernia, partial removal of the herniated organs from the fetal chest is not only possible by minimally invasive fetoscopic techniques but also well tolerated. As the effect of FETO alone is limited in saving severely affected fetuses, combining FETO with fetoscopic laparoschisis (FETO-LAP) offers a new therapeutic route with multiple, potentially life-saving implications. MDPI 2023-10-30 /pmc/articles/PMC10670710/ /pubmed/38002849 http://dx.doi.org/10.3390/children10111758 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Kohl, Thomas
Riehle, Nadja
Messroghli, Leila
Maus, Sibylle
Otto, Christiane
Klinke, Michaela
Martel, Richard
Beck, Grietje
Boettcher, Michael
Schaible, Thomas
Case Report: Fetoscopic Laparoschisis (FETO-LAP)—A New Therapeutic Route to Explore for Fetuses with Severe Diaphragmatic Hernias
title Case Report: Fetoscopic Laparoschisis (FETO-LAP)—A New Therapeutic Route to Explore for Fetuses with Severe Diaphragmatic Hernias
title_full Case Report: Fetoscopic Laparoschisis (FETO-LAP)—A New Therapeutic Route to Explore for Fetuses with Severe Diaphragmatic Hernias
title_fullStr Case Report: Fetoscopic Laparoschisis (FETO-LAP)—A New Therapeutic Route to Explore for Fetuses with Severe Diaphragmatic Hernias
title_full_unstemmed Case Report: Fetoscopic Laparoschisis (FETO-LAP)—A New Therapeutic Route to Explore for Fetuses with Severe Diaphragmatic Hernias
title_short Case Report: Fetoscopic Laparoschisis (FETO-LAP)—A New Therapeutic Route to Explore for Fetuses with Severe Diaphragmatic Hernias
title_sort case report: fetoscopic laparoschisis (feto-lap)—a new therapeutic route to explore for fetuses with severe diaphragmatic hernias
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10670710/
https://www.ncbi.nlm.nih.gov/pubmed/38002849
http://dx.doi.org/10.3390/children10111758
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