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Fetal Surgery for Gastroschisis—A Review with Emphasis on Minimally Invasive Procedures

(1) Background: The morbidity of gastroschisis is defined by exposure of unprotected intestines to the amniotic fluid leading to inflammatory damage and consecutive intestinal dysmotility, the viscero-abdominal disproportion which results in an abdomen too small to incorporate the herniated and ofte...

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Autores principales: Durmaz, Lidya-Olgu, Brunner, Susanne Eva, Meinzer, Andreas, Krebs, Thomas Franz, Bergholz, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8947425/
https://www.ncbi.nlm.nih.gov/pubmed/35327788
http://dx.doi.org/10.3390/children9030416
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author Durmaz, Lidya-Olgu
Brunner, Susanne Eva
Meinzer, Andreas
Krebs, Thomas Franz
Bergholz, Robert
author_facet Durmaz, Lidya-Olgu
Brunner, Susanne Eva
Meinzer, Andreas
Krebs, Thomas Franz
Bergholz, Robert
author_sort Durmaz, Lidya-Olgu
collection PubMed
description (1) Background: The morbidity of gastroschisis is defined by exposure of unprotected intestines to the amniotic fluid leading to inflammatory damage and consecutive intestinal dysmotility, the viscero-abdominal disproportion which results in an abdomen too small to incorporate the herniated and often swollen intestine, and by associated pathologies, such as in complex gastroschisis. To prevent intestinal damage and to provide for growth of the abdominal cavity, fetal interventions such as amnio exchange, gastroschisis repair or covering have been evaluated in several animal models and human trials. This review aims to evaluate the reported techniques for the fetal treatment of gastroschisis by focusing on minimally invasive procedures. (2) Methods: We conducted a systematic database search, quality assessment and analyzed relevant articles which evaluate or describe surgical techniques for the prenatal surgical management of gastroschisis in animal models or human application. (3) Results: Of 96 identified reports, 42 eligible studies were included. Fetal interventions for gastroschisis in humans are only reported for EXIT procedures and amnio exchange. In animal models, particularly in the fetal sheep model, several techniques of open or minimally invasive repair of gastroschisis or covering the intestine have been described, with fetoscopic covering being the most encouraging. (4) Discussion: Although some promising minimally invasive techniques have been demonstrated in human application and animal models, most of them are still associated with relevant fetal morbidity and mortality and barely appear to be currently applicable in humans. Further research on specific procedures, instruments and materials is needed before any human application.
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spelling pubmed-89474252022-03-25 Fetal Surgery for Gastroschisis—A Review with Emphasis on Minimally Invasive Procedures Durmaz, Lidya-Olgu Brunner, Susanne Eva Meinzer, Andreas Krebs, Thomas Franz Bergholz, Robert Children (Basel) Review (1) Background: The morbidity of gastroschisis is defined by exposure of unprotected intestines to the amniotic fluid leading to inflammatory damage and consecutive intestinal dysmotility, the viscero-abdominal disproportion which results in an abdomen too small to incorporate the herniated and often swollen intestine, and by associated pathologies, such as in complex gastroschisis. To prevent intestinal damage and to provide for growth of the abdominal cavity, fetal interventions such as amnio exchange, gastroschisis repair or covering have been evaluated in several animal models and human trials. This review aims to evaluate the reported techniques for the fetal treatment of gastroschisis by focusing on minimally invasive procedures. (2) Methods: We conducted a systematic database search, quality assessment and analyzed relevant articles which evaluate or describe surgical techniques for the prenatal surgical management of gastroschisis in animal models or human application. (3) Results: Of 96 identified reports, 42 eligible studies were included. Fetal interventions for gastroschisis in humans are only reported for EXIT procedures and amnio exchange. In animal models, particularly in the fetal sheep model, several techniques of open or minimally invasive repair of gastroschisis or covering the intestine have been described, with fetoscopic covering being the most encouraging. (4) Discussion: Although some promising minimally invasive techniques have been demonstrated in human application and animal models, most of them are still associated with relevant fetal morbidity and mortality and barely appear to be currently applicable in humans. Further research on specific procedures, instruments and materials is needed before any human application. MDPI 2022-03-15 /pmc/articles/PMC8947425/ /pubmed/35327788 http://dx.doi.org/10.3390/children9030416 Text en © 2022 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 Review
Durmaz, Lidya-Olgu
Brunner, Susanne Eva
Meinzer, Andreas
Krebs, Thomas Franz
Bergholz, Robert
Fetal Surgery for Gastroschisis—A Review with Emphasis on Minimally Invasive Procedures
title Fetal Surgery for Gastroschisis—A Review with Emphasis on Minimally Invasive Procedures
title_full Fetal Surgery for Gastroschisis—A Review with Emphasis on Minimally Invasive Procedures
title_fullStr Fetal Surgery for Gastroschisis—A Review with Emphasis on Minimally Invasive Procedures
title_full_unstemmed Fetal Surgery for Gastroschisis—A Review with Emphasis on Minimally Invasive Procedures
title_short Fetal Surgery for Gastroschisis—A Review with Emphasis on Minimally Invasive Procedures
title_sort fetal surgery for gastroschisis—a review with emphasis on minimally invasive procedures
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8947425/
https://www.ncbi.nlm.nih.gov/pubmed/35327788
http://dx.doi.org/10.3390/children9030416
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