Laparotomy-assisted fetoscopic repair of fetal spina bifida in Latin America: can we obtain similar results from the MoMs trial?

There is limited data in middle-income countries on implementing laparotomy-assisted fetoscopic repair of fetal spina bifida. The aim was to report obstetrical, perinatal, and neurosurgical outcomes in cases of fetoscopic repair in two centres in Latin America and to compare it with the open fetal surgery group in the MoMs trial. Prospective cohort study including 32 cases (18 from Colombia and 14 from Mexico) performed between 2019 and 2023. Results from this group were compared against the open fetal repair group in the MoMs (N = 78). Between-group comparisons were performed using the student's t-test or Mann–Whitney U tests and the Pearson's chi-square test was used to compare proportions. The GA at surgery was significantly higher in fetoscopic repair centres (p < 0.001), while the GA at delivery was significantly lower in the open fetal surgery group of the MoMs trial, with higher rate of term births in fetoscopic repair centres. The rate of Caesarean was lower in the fetoscopic group (p < 0.001). At 12 months of age, there was no significant difference in the dehiscence rate at the spinal repair or treatment for hydrocephalus between the fetoscopic repair centres and open fetal surgery group. Laparotomy-assisted fetoscopic spina bifida repair is a feasible surgical option in middle-income countries, with postnatal outcomes equivalent to those reported by open fetal surgery repair. Importantly, this approach can reduce prematurity and allows for vaginal delivery.