Intrauterine repair of gastroschisis in fetal rabbits

Objective: Infants with gastroschisis (GS) still face severe
morbidity. Prenatal closure may prevent gastrointestinal organ
damage, but intrauterine GS repair (GSR) has not been established
yet. Methods: In New Zealand White rabbits we developed and
compared GS versus GSR: creation of GS was achieved by hysterotomy,
right-sided laparotomy of the fetus and pressure on the abdominal
wall to provoke evisceration. GSR was accomplished by careful
reposition of eviscerated organs and a running suture of the fetal
abdominal wall. For study purposes, 18 animals were divided equally
into 3 groups: GS, GS with GSR after 2 h, and unmanipulated
controls (C). Vitality was assessed by echocardiography. After 5 h
all animals were sacrificed. Results: GSR inflicted no increased
mortality, because all fetuses survived GS or GS with GSR. All
fetuses with GS demonstrated significant evisceration of abdominal
organs. In contrast, the abdominal wall of the fetuses from GSR was
intact. Conclusion:The present animal model demonstrated the
technical feasibility and success of an intrauterine repair of GS
for the first time. However, further long-term studies (leaving GS
and GSR in utero for several days) will be necessary to compare
survival rates and intestinal injury, motility or absorption. The
clinical application of GSR in utero remains a vision so far.
Copyright (C) 2003 S. Karger AG, Basel.