British baby first to undergo in-womb surgery for complex gastroschisis

Theo became the first British baby to undergo surgery in the womb for complex gastroschisis, a severe birth defect in which the intestines develop outside the body through an opening in the abdominal wall. The operation was part of a fetoscopic trial led by Baylor College of Medicine and Texas Children’s Hospital, and it is testing whether fixing the defect before birth can improve outcomes for babies at highest risk.

Complex gastroschisis is more dangerous than the simpler form because it can involve extra bowel damage, twisting, blockage or other complications. The study, registered as NCT05704257 and titled Fetal Repair of Complex Gastroschisis: A Safety and Feasibility Trial, is focused on this narrower group rather than all babies born with gastroschisis. The trial aims to enroll 10 patients and will track maternal, fetal, neonatal and infant outcomes after fetoscopic repair.

The question is whether in-utero repair can lower postnatal morbidity and mortality with minimal risk to mother and fetus. That remains an experimental question, not routine care. A 2022 review identified complex gastroschisis as a possible new indication for fetal surgery.

The case also lands in a broader UK history of fetal surgery. Great Ormond Street Hospital performed the first British womb surgery for spina bifida in October 2018, and University College London later documented a successful birth after in-womb spina bifida surgery in April 2019.

Sheffield Children’s NHS Foundation Trust said Theo’s family were “blown away by the care we received on the intensive care unit.”