Surgeons say they have found a way to forestall a usually fatal birth defect by opening up the mother, operating on the fetus and putting it back in the womb to develop normally.
Experts say the operation, which involves re-arranging the fetus's organs, is the most extensive fetal operation ever successfully performed. However, it is also controversial because of the risks to both the mother and fetus.The first successful operation was performed on Blake Schultz, now 9 months old, the son of Elizabeth and Richard Schultz of Waterloo, Mich. "I'm just glad he's healthy. And hopefully it will help other people, too," Elizabeth Schultz said.
The surgery was pioneered at the University of California, San Francisco, to correct fetal diaphragmatic hernia, a defect that occurs in about one of every 2,000 babies. About three-quarters of all babies with the defect die.
During development, a hole in the fetus's diaphragm fails to grow shut, and the stomach, intestines and other organs squeeze into the chest cavity. As a result, the lungs fail to develop, and the baby is born unable to breathe.
"This problem is immensely frustrating for pediatric surgeons, because the babies are otherwise perfectly nice but they die," said Dr. Michael R. Harrison, who developed the surgery. "It seemed as though this was one of those situations in medicine where fixing it earlier would be the only way to have an impact."
Harrison has performed the highly experimental surgery eight times. The first six fetuses died, but the last two went on to become healthy children, Blake Schultz and a girl. A report on the first success was published in Thursday's New England Journal of Medicine.
During the surgery, doctors cut into Schultz's uterus and pulled the fetus's arm through the hole.
Then they put the misplaced stomach, intestines and other organs back where they belonged and covered the hole in the diaphragm with a Gore-Tex patch. Finally they tucked the fetus's arm back into the womb and closed up the incision.
Schultz carried the fetus for seven more weeks before giving birth. The baby was premature and had to spend a month on a respirator but is now healthy.
The second successful operation was performed March 3 on Devona Anderson, of Tacoma, Wash., now 6 weeks old. She came through the surgery better than Blake Schultz and was able to breathe on her own on her second day of life.
Her father, Stephen Anderson, said he and his wife, Lora, were devastated when they learned the fetus had only a 25 percent chance of survival if born with the defect. "The more we thought, the more we thought, `Let's do it,' " he said.
The operation takes just under an hour and costs about $16,000.
At the University of Manitoba, Dr. Frank Manning said a major difficulty is separating those fetuses that will survive without surgery from those that are doomed, since the operation itself is highly dangerous to the fetus.
"I don't want to pour on cold water, because this is an innovative thing," said Manning. "But I can't give you unbridled enthusiasm and tell you this will be the panacea for diaphragmatic hernia."