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March 12, 2013

Ochsner Performs First In Utero Surgery in Gulf South

59661-colby-originalColby Boudreaux is moving his legs and feet. While this is something most parents take for granted, for Colby it’s remarkable. He underwent a life-changing surgery at Ochsner Medical Center in New Orleans to correct the myelomeningocele birth defect, the most serious form of spina bifida, 12 weeks before he was born. During a groundbreaking surgery, Ochsner Medical Center’s fetal surgery team of 18 physicians and nurses operated on the 23-week-old fetus while still in his mother’s uterus, a procedure that fewer than 10 hospitals in the United States are able to perform.

Myelomeningocele (MMC) affects approximately one in every 1000 babies born in the United States each year. MMC occurs when the spinal cord is exposed through an opening in the spine, leaving nerves exposed and vulnerable to injury from amniotic fluid. It can lead to hydrocephalus (a buildup of spinal fluid in the brain which can cause neurological disabilities), problems with movement of the lower limbs, sensation impairment, and bladder and bowel issues for the rest of the child’s life.

Traditionally, surgeons wait to repair the defect until after a baby is born. But, the landmark 2011 Management of Myelomeningocele Study (MOMS) found that babies who received the surgery prenatally were half as likely to need a ventricular shunt (a plastic tube placed inside the brain to reduce pressure), twice as likely to walk independently at two years of age and had better motor function than those who had surgery after birth.

During the delicate two hour operation, Ochsner’s fetal surgery team worked together to repair the hole in Colby’s back. The mother’s uterus was opened by the maternal fetal medicine physicians and the fetus was lifted and held just slightly out of his mother’s womb where the MMC defect in his spine was closed by the pediatric neurosurgeon. After a plastic surgeon closed his skin incision, he was placed back into the uterus and the MFM doctors then closed the uterus tightly. During the procedure, two pediatric cardiologists and two obstetric anesthesiologists monitored Colby and his mother to make sure they remained stable. A neonatology team stood by in case of an emergent delivery. At the time of surgery, little Colby weighed just over one pound.

When he was born 12 weeks later, Colby weighed 4 pounds, 12 ounces. His physicians are thrilled with his prognosis, saying it is the best result they could have hoped for. Colby left the hospital with excellent leg movements, functioning bowel and bladder, and no evidence of hydrocephalus.



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