Prenatal coverage of experimental gastroschisis with a collagen scaffold to protect the bowel

Luc A. J. Roelofs*, Paul J. Geutjes, Christina A. Hulsbergen-van de Kaa, Alex J. Eggink, Toin H. van Kuppevelt, Willeke F. Daamen, A. Jane Crevels, Paul P. van den Berg, Wout F. J. Feitz, Rene M. H. Wijnen, CA Hulsbergen-van de Kaa

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background/Purpose: In fetuses with gastroschisis, toxic products in the amniotic fluid and constriction at the defect of the abdominal wall are considered causative of damage to the eviscerated bowel. The aim of this study was to cover the eviscerated bowel in gastroschisis with a collagen scaffold to protect the bowel and induce cell growth into the scaffold, which could lead to skin or abdominal wall formation replacing the scaffold.

Methods: In 12 fetal lambs gastroschisis was surgically created at 79 days gestation. A dual-layer type I collagen scaffold was sutured into the skin of the abdominal wall around the defect covering the eviscerated bowel. Lambs were examined after caesarean section at 140 days' gestation.

Results: Survival was 67%. In 7 of 8 surviving lambs the bowel was found to be covered after birth. One scaffold had ruptured. The bowel was found repositioned in the abdominal cavity in 5 lambs. In 2 lambs it was still partially outside. Only minor adherence of bowel loops and no fibrous peel formation were seen. Connective tissue and skin tissue replaced the scaffold.

Conclusions: Prenatal coverage of the bowel in experimental gastroschisis with a collagen scaffold is feasible in fetal lambs, significantly diminished damage to the bowel wall, and skin and connective tissue replaced the scaffold. This technique may be promising in the care of fetuses with this congenital anomaly. (C) 2013 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)516-524
Number of pages9
JournalJournal of Pediatric Surgery
Volume48
Issue number3
DOIs
Publication statusPublished - Mar-2013

Keywords

  • Abdominal wall defect
  • Collagen scaffold
  • Fetal surgery
  • Gastroschisis
  • Tissue engineering
  • ABDOMINAL-WALL DEFECTS
  • INTESTINAL DAMAGE
  • AMNIOTIC-FLUID
  • FETAL SURGERY
  • SHEEP MODEL
  • REPAIR
  • BIOMATRIX
  • MECONIUM
  • ETIOLOGY
  • MATRICES

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