Eur J Pediatr Surg 2017; 27(04): 297-305
DOI: 10.1055/s-0036-1587331
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Procedure-Related Complications and Survival Following Fetoscopic Endotracheal Occlusion (FETO) for Severe Congenital Diaphragmatic Hernia: Systematic Review and Meta-Analysis in the FETO Era

Edward Araujo Júnior
1  Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
Gabriele Tonni
2  Department of Obstetrics and Gynaecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
Wellington P. Martins
3  Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, São Paulo University (FMRP-USP), Ribeirão Preto-SP, Brazil
Rodrigo Ruano
4  Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, United States
› Author Affiliations
Further Information

Publication History

21 June 2016

25 June 2016

Publication Date:
14 August 2016 (online)


Introduction This study aims to assess the procedure-related complications and survival following fetoscopic endotracheal occlusion (FETO) for severe congenital diaphragmatic hernia.

Materials and Methods A systematic review and meta-analysis of PubMed and Scopus database searching for FETO procedure in severe CDH (lung-to-head ratio [LHR] < 1.0 and/or observed/expected LHR < 0.26 and > 1/3 liver herniation) were performed. The relative risk was assessed and 95% confidence interval (CI) calculated. Procedure complications and survival were compared between FETO and randomized controlled trial (RCT) as well as observational case–control studies.

Results A total of 4,807 records were retrieved based on the title and abstracts, and 18 studies were eligible for statistical analysis (1 RCT and 17 observational case–control studies). Relative risk (95% CI) comparing FETO and controls for premature rupture of membrane, preterm birth < 32 weeks, preterm birth < 37 weeks, survival at 30 days, and survival at 6 months were 1.7 (0.8–2.4), 7.3 (0.4–134), 1.8 (0.8–3.9), 5.8 (1.5–22.9), and 10.5 (1.5–74.7), respectively. Mean difference (95% CI) for gestational age at delivery comparing FETO and controls was 1.8 (−3.1 to −0.5). All these outcomes showed a low level of evidence.

Conclusion FETO procedure increased the neonatal survival at 30 days and 6 months; however, it presented a higher rate of premature rupture of membrane, preterm birth < 37 weeks, and decreased the gestational age at delivery by 2 weeks. Nonetheless, the level of evidence is low for all these outcomes. We suggested a large international multicenter RCT to prove the real benefits of FETO.