Monitoring and treating fetuses with gastroschisis using the Svetliza Reducibility Index (SRI) and the EXIT-like procedure - a novel approach

Velhote, Manoel Carlos Prieto

doi:10.1590/s1679-45082017ed4238

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…According to this procedure, the gastroschisis is treated with a primary closure of the prolapsed bowel before the newborn takes its first breath, which would result in bowel expansion [41]. To assess the feasibility of EXIT, prenatal ultrasound parameters are determined such as the Svetliza Reducibility Index (SRI), which is calculated by the largest diameter of the intestinal loops, the thickness of the loop wall, and the size of the abdominal wall defect [42].…”

Section: Exit Proceduresmentioning

confidence: 99%

“…To assess the feasibility of EXIT and similar procedures, the SRI index used so far seems to be indicative, as a smaller abdominal wall defect makes repositioning of the bowel loops more difficult, especially under time pressure. In these cases, surgical enlargement of the defect would be a solution but is unfeasible without anesthesia [42].…”

Section: Exit Proceduresmentioning

confidence: 99%

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

et al. 2022

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(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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Section: Exit Proceduresmentioning

confidence: 99%

Section: Exit Proceduresmentioning

confidence: 99%

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

et al. 2022

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“…In doing so, the ultimate goal is to transform an emergency neonatal airway situation into a controlled, elective procedure that ensures the well-being of both the mother and the newborn, ultimately facilitating a life-saving transition for the neonate [4,10,12,15,20]. Thanks to the expansion of EXIT indications, the procedure has been increasingly utilized for the correction of non-cardiorespiratory fetal pathologies, allowing a complete repositioning of the prolapsed bowel during the fetal stage and preventing bowel expansion after neonatal breathing [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

Domínguez-Moreno,

Chimenea,

Viegas-González

et al. 2024

Surgical Techniques Development

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The Ex Utero Intrapartum Treatment (EXIT) procedure has long been an invaluable tool in managing complex fetal conditions requiring airway interventions during the transition from intrauterine to extrauterine life. This technical note offers an in-depth examination of the EXIT procedure, emphasizing the refinements and innovations introduced at our center. The technique focuses on meticulous preoperative assessment and uses distinctive techniques and anesthetic methodologies. A multidisciplinary team assembles to plan the EXIT procedure, emphasizing patient communication and risk discussion. Our technique involves atraumatic access to the uterine cavity, achieved through the application of a uterine progressive distractor developed for this purpose. Following the use of this distractor, vascular clamps and a stapling device (Premium Poly Cs-57 Autosuture®, Medtronic) are employed. Our anesthetic approach employs general anesthesia with epidural catheter placement. Maternal operation involves low transverse laparotomy and intraoperative ultrasonography-guided hysterotomy. Fetal exposure includes gentle extraction or external version, ensuring airway access. After securing fetal airway access, umbilical cord clamping and maternal abdominal closure conclude the procedure. By revisiting the core principles of EXIT and incorporating center-specific advancements, we enhance our understanding and technical expertise. To our knowledge, this is the first time a detailed description of the technique has been published.

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Comparison of the main types of surgical closure in newborns with gastroschisis in Bahia, Brazil

Gutiérrez-Peredo

Montaño-Castellón

et al. 2022

Asian Journal of Surgery

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Monitoring and treating fetuses with gastroschisis using the Svetliza Reducibility Index (SRI) and the EXIT-like procedure - a novel approach

Cited by 4 publications

References 8 publications

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

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

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

Comparison of the main types of surgical closure in newborns with gastroschisis in Bahia, Brazil

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