SJD and Clínic have performed Europe’s first operation on a foetus whose entire intestine had developed outside its body

The medical team at SJD Barcelona Children’s Hospital and Hospital Clínic Barcelona decided to perform foetal surgery at 28 weeks’ gestation to prevent irreversible damage to the baby.

A team comprising specialists from BCNatal – a consortium specialising in maternal-foetal medicine and neonatology comprising SJD Barcelona Children’s Hospital and Hospital Clínic Barcelona – and specialists in paedi­atric surgery and anaesthesiology from SJD Hospital has, for the first time in Europe, op­erated on a foetus which, due to a severe mal­formation, had developed its entire intestine outside its body. The baby, who underwent surgery in the womb during the 28th week of gestation, was born six weeks later and is cur­rently feeding normally.

The foetus had gastroschisis, a congeni­tal malformation in which the baby’s intes­tines (and sometimes other organs) devel­op outside the body through an opening in the abdominal wall, located to the right of the umbilical cord, which does not close properly during pregnancy. As they are unprotected, the intestines are exposed to amniotic fluid, become inflamed, lose blood supply and may suffer necrosis, with very serious consequences for the baby af­ter birth.

The healthcare professionals monitor­ing the pregnancy of the mother, a Co­lombian 20-year-old woman, detected the foetal malformation during a routine ultrasound scan in the 20th week of gesta­tion and referred her to BCNatal, a leading centre in obstetrics and foetal medicine. After evaluating the various options and consulting the case with the ethics com­mittee, the medical team treating the ex­pectant mother proposed a foetal surgery that has so far been performed only on very rare occasions in Colombia and the United States, but never in Europe.

A successful operation
The foetal surgery took place on 10 Feb­ruary, lasted two and a half hours and was carried out by a team comprising specialists in foetal medicine and surgery, paediatric surgery, anaesthesiology and neonatology.

The surgeons made an incision in the mother’s abdomen to access the uterus; they then repositioned the foetus to al­low access to its abdomen and performed the procedure laparoscopically. To do this, they inserted four trocars into the amni­otic sac and, after draining the fluid and introducing gas to create space within the abdomen that would allow them to see and operate safely, they carefully repositioned the intestine within the abdominal wall. Upon completion, they closed the incision in the abdomen. This is a procedure that requires a high degree of precision, given that the foetus weighed 700 grams, the intestine was 80 centimetres long and had a diameter of 3 to 15 mm, and had to be reinserted through a puncture measuring just 1.5 centimetres.

In the days following the procedure, ul­trasound scans confirmed that the inflam­mation in the intestine was subsiding and that it was returning to its normal appear­ance. The pregnancy continued and the baby was delivered by caesarean section at 34 weeks’ gestation. Although the baby was underweight for its gestational age, the outcome was very favourable and, after a short stay in hospital, the baby was dis­charged.

Gastroschisis occurs in between 2 and 3 out of every 10,000 births (which translates to 120 cases annually in Spain and 2,400 in Europe), but foetal surgery would only be indicated in 10% of these cases.