A 25-week-old unborn Johannesburg baby has become the first foetus in Africa to receive anaesthetic and undergo groundbreaking “keyhole” surgery to the spine.
The four-hour procedure, which involved removing the womb and resting it on the mother’s skin, was performed by a team led by US Baylor College of Medicine professor Mike Belfort, who was born and trained in SA.
As was the case of this particular patient, identifying the problem during the pregnancy empowered the prospective parents to inform themselves about the condition and enabled them to make an informed decision about the way forward.
Nicolaou said parents could choose to terminate the pregnancy or have the baby and have a number of surgeries after delivery to repair the defect on the spine, the brain and the feet, and take measures to improve the problem of incontinence.
“The in-utero surgery will provide them with an additional option where a repair can be performed before the baby is born,” he said.
Nicolaou believes that the repair of spina bifida in utero may stop the inflammatory process that leads to the damage of the nerves and potential abnormalities.
As the operation is performed with tiny instruments through the uterine wall and by not cutting the uterus open, the recovery period is a lot faster and the patient may go on to have a normal vaginal delivery if she wishes. “This is a very delicate surgery and the success varies.
In utero laparoscopic repair can also have complications such as foetal death or premature labour. Careful evaluation and selection of these cases is very important,” Nicolaou said.
After the immediate post-operative period, close monitoring of both the mother and foetus until delivery will be mandatory. Once the baby is born, the neurosurgeon who was a member of the operating team will assess the baby and decide if further corrective procedures will be required.
“The overall incidence of neural tube defects and spina bifida is around 1 in 1 000 pregnancies. We have around 1 million live births in South Africa every year, so we are looking at around 1000 new cases of neural tube defects every year in our country.
“Our plan is to expand our foetal surgery service to other abnormalities as well,” Nicolaou said.
“A few examples of what the team would be able to offer are operations on the heart, lungs, abdomen, kidneys and bladder. “One has to be very clear that operations on foetuses will only be considered if the foetal abnormality is so severe that it will lead to foetal death or severe handicap,” Nicolaou said.
(Source: Cape Times)
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