(1076) Outcomes after prenatal (Fetoscopic and open) and postnatal repair for spina bifida by 30 months

To compare outcomes of fetuses who underwent a laparotomy-assisted fetoscopic repair against those who underwent open fetal surgery or postnatal repair.


Study Design:

Retrospective cohort study of 191 patients who underwent spina bifida repair between 2011-2021 at a single center. Patients were eligible for prenatal repair using MOMS criteria (BMI up to 40kg/m²). Method for in utero repair was based on patient’s decision. Fetoscopic repair was performed by using CO₂ uterine insufflation and two trocar insertion into the uterine cavity. Postnatally-repaired cases were eligible for prenatal surgery from a fetal standpoint.


Results:

A total of 112 fetoscopic, 39 open fetal surgery and 40 postnatal repaired cases were included. Fetoscopic (15.2%) and open (12.8%) repaired cases had a lower rate of clubfeet than in postnatal repair (32.5%; p=0.01 and p=0.03).(Table 1)

In the fetoscopic group, surgeries occurred later [25.1(22.9-26.4) vs 24.9(21.3-25.6) weeks; p< 0.01], they were longer (253.95 + 48.66 vs 154.49 + 24.45 minutes; p< 0.01) and hospital stays were shorter [5(3-49) vs 6(4-18) days; p< 0.01] than in the open group.
Gestational age at delivery was more advanced in the fetoscopic [37.9 (25.1-40.9)weeks] and postnatal repair [38.5(33.7-39.9) weeks]groups than in open cases [35.7 (26.4-37.9)weeks; p< 0.01 and p< 0.01].

Cesarean delivery was more frequent in open than in fetoscopic cases (100% vs 48.6%; p< 0.01) and in the former, it was more frequent to find areas of thinning or dehiscence at the time of C-section (38.7% vs 0%; p< 0.01).

Fetoscopic (38.9%) and open (30.3%) repaired cases had a significantly lower rate of hydrocephalus treatment than after postnatal repair (72.5%; p< 0.01 and p< 0.01) by 12 months. 
At 30 months, no differences in ambulation were observed between fetoscopic and open cases. Both groups had significantly better ambulatory skills than postnatally repaired cases (Table 2)


Conclusion: Laparotomy-assisted fetoscopic repair approach provides significant benefits to the mother and the baby and provides equivalent neurosurgical outcomes than the open fetal surgery approach.