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Open intrauterine fetal Myelomeningocele repair: Learning curve of the surgical procedure and perinatal complications
20 September 2018 (online)
Fetal myelomeningocele (fMMC) repair is nowadays the preferred therapeutic procedure in classifying cases. We aimed at the evaluation of the effects of operator and perinatal treatment experience on the perinatal outcome in a tertiary referral fetal medicine center in Switzerland.
Material and methods:
Between 2010 and 2017 fMMC repair including the delivery of the neonate via planned caesarean section was performed in 67 cases at the “Zurich Center for Fetal Diagnosis and Therapy”. Pregnancy characteristics, operation variables and outcomes were collected. Cases were stratified into two groups: a “teaching phase” (TP) with supervision from an external surgeon during 11 operations (2010 – 2014, 15 cases) followed by an „experienced phase” (EP, 2014 – 2017, 52 cases).
Analyses did not reveal differences between TP and EP in major outcome parameters such as gestational age at delivery, PPROM, chorionic membrane separation or placental abruption incidence. While profoundly more complex surgical techniques were applied in EP (e.g. patch closure, dermal closure using rotational flap), total surgery time was not different from TP. At the same time, surgical complications such as oligohydramnios (27% vs. 8%, p= 0.046) with MRI-confirmed leakage (13% vs. 4%, p= ns) and subcutaneous hematoma (20% vs. 2%, p= 0.009) were less common in EP compared to TP.
This study shows that the level of operator competence, regarding major outcome parameters, was already high with the initial 15 patient cases of fMMC repair. However, more complex surgical techniques and significantly less minor complications such as oligohydramnios and subcutaneous hematomas were observed after the training phase.