Prenatal Fetoscopic Intervention for Gastroschisis: A Systematic Review of First Published Human Cases.

Abstract

Objective: To systematically identify and descriptively summarize the available published human evidence on prenatal fetoscopic intervention for gastroschisis, focusing on reported procedural characteristics, maternal-fetal events, neonatal outcomes, and limitations of the current literature.

Methods: A systematic review was conducted according to PRISMA guidance, with protocol registration in PROSPERO (CRD420261338353). MEDLINE/PubMed, Embase, CINAHL, CENTRAL, Scopus, and Web of Science were searched from inception to March 2026. Studies including fetuses with prenatally diagnosed gastroschisis undergoing intrauterine intervention were eligible. Two reviewers independently screened studies, extracted data using a standardized form, and assessed reporting quality using the Joanna Briggs Institute checklist for case reports. Given the nature of the available evidence, synthesis was descriptive only.

Results: Of 827 records identified, three single-patient case reports met the inclusion criteria. All described prenatal fetoscopic intervention for gastroschisis in highly specialized centers, with substantial heterogeneity in timing of intervention, uterine access, carbon dioxide insufflation, amniotic fluid management, closure technique, fetal monitoring, and postoperative surveillance. Initial intrauterine bowel reduction was reported in all three cases; however, one fetus developed postoperative bowel re-extrusion within 48 hours, associated with venous Doppler abnormalities, and required delivery followed by EXIT-like repair. All neonates survived, but the absence of comparators, extreme case selection, heterogeneous perioperative management, and likely publication bias preclude any inference regarding efficacy or neonatal benefit.

Conclusions: Published human evidence on prenatal fetoscopic intervention for gastroschisis is limited to three isolated case reports. These reports describe procedural completion in highly selected cases managed at specialized fetal surgery centers, but they remain insufficient to determine the generalizable feasibility, safety profile, reproducibility, or clinical benefit of this approach compared with contemporary postnatal management. Prenatal repair should therefore remain investigational and should be evaluated within ethically approved prospective protocols with standardized selection criteria, maternal-fetal safety monitoring, operative reporting, and long-term follow-up.