Open repair versus fetoscopic fetal surgery: Which is the best approach for intrauterine myelomeningocele correction? Systematic review and meta-analysis.

OBJECTIVE

The Management of Myelomeningocele Study in 2011 the prenatal approach has become the gold standard for the correction of myelomeningocele. Since then, advancements in minimally invasive techniques, including fetoscopic repair, have aimed to minimize maternal complications while maintaining fetal benefits.This systematic review and meta-analysis examines the maternal and neonatal outcomes of open versus fetoscopic myelomeningocele repair in utero.

METHODS

We systematically searched PubMed and LILACS databases for studies published between 2011 and 2024, following PRISMA guidelines. Data on maternal and fetal outcomes were extracted and analyzed. A total of 32 studies were included.

RESULTS

Regarding maternal and fetal complications in open and fetoscopic surgery, the rates were respectively: premature rupture of membranes (0.298 95% CI: 0.202-0.393 vs. 0.522 95% CI: 0.254-0.790), oligohydramnios (0.145 95% CI: 0.086-0.203; vs. 0.488 95% CI: 0.162-0.813), premature placental abruption (0.032 95% CI: 0.015-0.048 vs. 0.042 95% CI: 0.0-0.084), birth weight (2261.330 g 95% CI: 2125.819-2369.84; vs. 2251.531 g 95% CI: 1845.674-2657.389), prematurity < 37 weeks (0.789 95% CI: 0.729-0.849 vs. 0.636 95% CI: 0.208-1.064), neonatal sepsis (0.097 95% CI: 0.030-0.163 vs. 0.251 95% CI: 0.046-0.455), surgical time (133.7 min 95% CI: 92.070-175.394 vs. 220.4 min 95% CI: 194.264-246.607), neonatal surgical wound dehiscence (0.043 95% CI: 0.023-0.064 vs. 0.137 95% CI: 0.052-0.222), hydrocephalus (0.422 95% CI: 0.256-0.588 vs. 0.391 95% CI: 0.272-0.510), reversal of brainstem herniation (0.601 95% CI: 0.385-0.816 vs. 0.581 95% CI: 0.356-0.806), maintenance or improvement in motor function (0.809 95% CI: 0.692- 0.927 vs. 0.856 95% CI: 0.734-0.978). Only neonatal sepsis in the fetoscopic surgery group was not statistically significant (p < 0.05).

CONCLUSIONS

The open approach, traditionally associated with better fetal outcomes, showed better outcomes for maternal complications compared to fetoscopic surgery.