Palliative fetal surgery for diaphragmatic hernia

Porreco, Richard P.; Chang, Jack; Quissell, Barbara J.; Morgan, Mark A.

doi:10.1016/s0002-9378(94)70293-4

Cited by 11 publications

(7 citation statements)

References 2 publications

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“…Although lung development and survival of a fetus with a diaphragmatic hernia after surgical creation of a gastroschisis at 22 weeks' gestation has been reported, lung development did not proceed normally after the second-trimester rupture of the anterior abdominal wall in our case, despite the temporary reaccumulation of amniotic fluid. 4 Without an autopsy, it was not possible to distinguish urethral atresia from posterior urethral valves. In this case, diminished lung length accurately predicted the presence of pulmonary hypoplasia.…”

Section: Discussionmentioning

confidence: 99%

Fetal Urethral Obstruction With Spontaneous Rupture of the Bladder and Creation of a Gastroschisis

Dinsmoor

Seeds²

2002

J of Ultrasound Medicine

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Section: Discussionmentioning

confidence: 99%

Fetal Urethral Obstruction With Spontaneous Rupture of the Bladder and Creation of a Gastroschisis

Dinsmoor

Seeds²

2002

J of Ultrasound Medicine

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“…One procedure has been the aspiration of pleural effusions associated with diaphragmatic herniae and other space-occuping lesions in the thorax [62], with 1 of 3 fetuses with a CDH surviving at birth, and 1 with a sequestration also sur viving [62], Another procedure has been the creation of an iatrogenic gastroschisis to ame liorate the pressure effects on the lungs [63], This has been successful in 1 human fetus who survived after birth [64].…”

Section: Techniques For Fetal Surgerymentioning

confidence: 99%

“…One fetus has undergone the procedure [64] and the fetus survived with major intestinal complications after birth. By 9 months of age the child was off all treatment.…”

Section: Iatrogenic Gastroschisismentioning

confidence: 99%

Fetal Intervention for Congenital Diaphragmatic Hernia

Ford

1994

Fetal Diagn Ther

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Despite improvements in surgical techniques, the results of open fetal surgery to correct congenital diaphragmatic hernia have been disappointing. Hysterotomy induces preterm labour and, where there is a large volume of liver in the fetal chest, reduction of the liver into the abdomen induces immediate fetal death. Less invasive techniques, using both open surgery and fetoscopy, are being developed in the hope of reducing fetal demise. These techniques include blocking the trachea, the creation of an artificial gastroschisis and induction of graft tolerance for postnatal lung transplantation.

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“…One procedure for the 'correction' of CDH that has the potential to be adapted to minimally invasive surgery is the 'PLUG' (Plug the Lung Until it Grows), where the tra chea is obstructed to stimulate the lung to grow in volume and mature, even in the presence of viscera in the chest [13][14][15], Another technique is the iatrogenic development of a gastroschisis in the fetus, to take pressure off the lungs [16,17],…”

Section: Introductionmentioning

confidence: 99%

Glycine as a Potential Window for Minimal Access Fetal Surgery

et al. 1997

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Carbon dioxide insufflation of the uterine cavity in sheep enables electrocautery to the surface and superficial tissues of the fetal lamb, using minimally invasive surgery. Absorption of the CO₂ however, causes a potentially lethal acidosis. To enable the use of electrocautery dissection of the fetal sheep, without using gas, we have partially replaced the amniotic fluid with 0.5% glycine. To determine whether glycine would have any short- or long-term deleterious effects on the developing fetus, we replaced amniotic fluid with 0.5% glycine in 10 normal fetuses at 101 days of gestation (normal gestation 145–149 days), without later replacing it with the removed amniotic fluid. Histological changes were then sought in the skin, gastrointestinal tract, and pulmonary tree, at 2 (‘early’, n = 5) or 6 weeks (‘late’, n = 5) after the introduction of the glycine. There were no histological differences between these and normal sheep at either time point. The use of glycine as a replacement for amniotic fluid subsequently enabled us to carry out electrocautery dissection of the sheep fetus and electrocoagulation of any bleeding vessel. Its use was not associated with any apparent untoward effects. Therefore, it has the potential to be used in minimally invasive surgery on the fetal trachea or on an enlarged fetal bladder.

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Palliative fetal surgery for diaphragmatic hernia

Cited by 11 publications

References 2 publications

Fetal Urethral Obstruction With Spontaneous Rupture of the Bladder and Creation of a Gastroschisis

Fetal Urethral Obstruction With Spontaneous Rupture of the Bladder and Creation of a Gastroschisis

Fetal Intervention for Congenital Diaphragmatic Hernia

Glycine as a Potential Window for Minimal Access Fetal Surgery

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