WOFAPS 2025 8th World Congress of Pediatric Surgery

Cristobal Abello ¹, Miguel Parra ², Jezid Miranda ², Amiel Pérez ³

¹ Chief of Pediatric Surgery, North Clinic Organization, Barranquilla, Colombia
² Caribbean Institute for Fetal Surgery and Therapy, Barranquilla, Colombia
³ Fetal and Neonatal Surgery Research Group (GICIFEN), Barranquilla, Colombia

Introduction

Gastroschisis is a congenital paraumbilical defect of the abdominal wall characterized by evisceration of the abdominal contents. In complex cases, it can lead to intestinal atresia, the second most frequent cause of short bowel syndrome worldwide, and even fetal death due to intrauterine complications. It remains a challenge for pediatric surgeons, although targeted interventions have achieved a survival rate close to 90%, there is evidence of a mortality of up to 21.4% in middle and low-income countries, mainly due to factors such as sepsis, intestinal ischemia, prolonged mechanical ventilation and associated with closure, increasing mortality up to 30 times.

Cases presentation

Three fetuses were prenatally diagnosed with complex gastroschisis at 22 weeks of gestation, evidenced by an intra-abdominal sentinel loop. At 24 weeks, a dose of 17 units per kilogram of botulinum toxin type A was administered percutaneously under ultrasound guidance into the bilateral oblique and rectus abdominis muscles of the fetal abdominal wall. One week later, ultrasound follow-up showed a discrete reduction in the head-to-abdominal circumference ratio. At 26 weeks, the defect was surgically repaired using fetoscopy assisted by laparotomy with exteriorization of the uterus. Two weeks postoperatively, ultrasound revealed complete healing of the abdominal wall defect, disappearance of the sentinel loop, normal fetal biophysical activity for gestational age, and increased abdominal circumference and fetal growth percentile. Neonates were born with adequate adaptation, no associated anomalies, initiated breastfeeding in the first 24 hours without complications, and were discharged on postoperative day seven with intact abdominal walls and no signs of evisceration.

Conclusion

In utero correction of gastroschisis is feasible using fetoscopy after prior muscle relaxation of the fetal abdominal wall. This approach may help minimize the devastating effects on perinatal outcomes and reduce long-term healthcare costs, especially in low- and middle-income settings