Modified Hysterotomy Closure Technique for Open Fetal Surgery.

Abstract

OBJECTIVE:

We reviewed our experience with open fetal surgical myelomeningocele repair to assess the efficacy of a new modification of the hysterotomy closure technique regarding hysterotomy complication rates at the time of cesarean delivery.

METHODS:

A modification of the standard hysterotomy closure was performed on all patients undergoing prenatal myelomeningocele repair. The closure consisted of an interrupted full-thickness #0 polydioxanone (PDS) retention suture as well as a running #0 PDS suture to re-approximate the myometrial edges, and the modification was a third imbricating layer resulting in serosal-to-serosal apposition. A standard omental patch was placed per our routine. Both operative reports and verbal descriptions of hysterotomy from delivering obstetricians were reviewed.

RESULTS:

A total of 49 patients underwent prenatal repair of myelomeningocele, 43 having adequate follow-up for evaluation. Of those, 95.4% had completely intact hysterotomy closures, with only 1 partial dehiscence (2.3%) and 1 thinned scar (2.3%). There were no instances of uterine rupture.

DISCUSSION:

In patients undergoing this modified hysterotomy closure technique, a much lower than expected complication rate was observed. This simple modified closure technique may improve hysterotomy healing and reduce obstetric morbidity.

• Authors: Michael V Zaretsky, Kenneth W Liechty, Henry L Galan, Nicholas J Behrendt, Shane Reeves, Ahmed I Marwan, Corbett Wilkinson, Michael Handler, Megan Lagueux, Timothy M Crombleholme
• Journal: Fetal diagnosis and therapy (Fetal Diagn Ther) Vol. 44 Issue 2 Pg. 105-111 ( 2018) ISSN: 1421-9964 [Electronic] Switzerland
• PMID: 28873371 (Publication Type: Journal Article)
• Copyright: © 2017 S. Karger AG, Basel.

Topics

• Adult
• Female
• Fetoscopy (methods)
• Follow-Up Studies
• Humans
• Hysterotomy (methods)
• Meningomyelocele (diagnosis, surgery)
• Pregnancy
• Prenatal Care (methods)
• Retrospective Studies