Modified Hysterotomy Closure Technique for Open Fetal Surgery

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

Research output: Contribution to journalArticle

10 Scopus citations

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.

Original languageEnglish (US)
JournalFetal Diagnosis and Therapy
DOIs
StateAccepted/In press - Sep 6 2017

Keywords

  • Dehiscence
  • Fetal surgery
  • Hysterotomy
  • Myelomeningocele
  • Spina bifida repair

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

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    Zaretsky, M. V., Liechty, K. W., Galan, H. L., Behrendt, N. J., Reeves, S., Marwan, A. I., Wilkinson, C., Handler, M., Lagueux, M., & Crombleholme, T. M. (Accepted/In press). Modified Hysterotomy Closure Technique for Open Fetal Surgery. Fetal Diagnosis and Therapy. https://doi.org/10.1159/000479683