Fetal repair of surgically-created gastroschisis in a lamb model may improve postnatal feeding tolerance and intestinal motility: A pilot study

Background

Gastroschisis remains a morbid and costly congenital defect, predominantly owing to sequelae of intestinal dysmotility and malabsorption. Although fetal surgical repair has been demonstrated in a lamb model, it is unclear whether this improves intestinal motility and feeding tolerance.

Methods

Fetuses from five time-mated ewes (Ovis aries) underwent defect creation at gestational age (GA) 76–80 days. The experimental group underwent in utero repair of gastroschisis at GA 99–100. The positive control group underwent postnatal repair of at time of cesarean section at GA 139–141. On day of birth, lambs were fed barium sulfate, followed by ad lib colostrum/milk. Lambs were monitored for up to 72 h to determine feeding tolerance and duration of time for complete passage of barium through the gastrointestinal tract.

Results

Eight fetuses underwent gastroschisis defect creation and five survived to birth. Of the three lambs repaired at birth, one required resection of necrotic bowel and two had significant intestinal stricture at the abdominal wall defect and did not tolerate feeding. Of the two lambs repaired in utero, one tolerated feeding normally without complications and one had a small intestine atresia preventing normal feeding.

Conclusion

Fetal repair of gastroschisis may improve postnatal intestinal motility resulting in feeding tolerance at birth.

Study type

Prospective comparative study.

Level of evidence

Level II.