Fetal surgery for diaphragmatic hernias: are we there yet?

This new Australian publication asks the question  in its title that many of us are asking. (Cundy TP, Gardener GJ, Andersen CC, Kirby CP, McBride CA, Teague WJ: Fetoscopic endoluminal tracheal occlusion (feto) for congenital diaphragmatic hernia in australia and new zealand: Are we willing, able, both or neither? Journal of Paediatrics and Child Health 2014).

In case you are wondering, this means doing an amnioscopy, and then doing a tracheoscopy on the fetus to deposit a balloon that occludes the trachea. Not a straightforward procedure! Then in some protocols a second procedure before term to remove the balloon. The article that I cited reviews the literature and notes that there are now 9 reports of various trials including 4 very small RCTs. Recent data show much less prematurity than the older publications, as techniques have evolved. The FETENDO technique does look like there is  a good chance that it decreases mortality in the most severe cases.

In answer to my own question, posed in the title, I don’t think we are ready for widespread adoption, but ongoing studies will be important. I think that perhaps the technique should be available for very high risk cases who are not willing to be randomized, but who will be evaluated prospectively, as an ‘innovative therapy’.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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