[Role of fetal surgery in the treatment of abnormalities. Apropos of diaphragmatic hernia]

Abstract

Therapeutic operations on fetuses have been attempted for the first time in the 60's. The major problem for obstetricians at that time was the Rh incompatibility, and Lilley performed the first successful intraperitoneal intrauterine fetal blood transfusion in 1963. Since then the attempts have become increasingly numerous, and experiments in animals proved their feasibility and surgical safety both for the mother and for the fetus. The possible advantages of fetal surgery are not readily assessed, and the indications for fetal surgery can currently be justified only if the natural history of the malformation is known, the physiopathology of the affected organ studied, and the correction of the anatomical abnormality proved to produce the resumption of organ development. The surgical indications should be discussed with practitioners not involved in the program, with the informed consent of the parents, and all the results, whatever they be, should be communicated to the medical community.