Fellow Leads Groundbreaking In-Utero Surgery to Treat Gastroschisis

A multidisciplinary team at Texas Children’s Hospital in Houston, led by ACS Fellow Sundeep Keswani, MD, MBA, FACS, a pediatric and fetal surgeon and associate surgeon-in-chief, used a minimally invasive fetal surgery technique to treat complex gastroschisis before birth, rather than waiting until delivery. 

Gastroschisis causes the fetal intestines to develop outside the abdominal cavity; in complex cases, prolonged exposure of the bowel can lead to severe inflammation, injury, intestinal dysfunction, prolonged neonatal intensive care, multiple operations, and increased mortality. 

The procedure, performed in November 2025 at 26 weeks’ gestation, was part of an FDA-authorized clinical trial and represented the first procedure of its kind reported in the US. 

Using a minimally invasive, fetoscopic approach, surgeons accessed the uterus through small incisions rather than performing a large hysterotomy. The uterus was partially exposed, amniotic fluid was drained and replaced, and the surgeons carefully reduced the fetal intestines back into the abdominal cavity and closed the abdominal wall. 

By restoring the abdominal environment while the fetus remains in utero, the intervention potentially limits bowel damage during the remainder of gestation and allows normal fetal growth and healing. The child subsequently remained in the womb until term, was born at normal weight, established full feeds within two days, and was discharged on the third day—an outcome dramatically different from the prolonged hospitalization and repeated operations that can accompany severe complex gastroschisis. 

The procedure remains investigational, with safety, patient selection, durability of repair, maternal risks, and longer-term neonatal outcomes requiring further study. If validated in larger cohorts, however, the approach could expand the role of fetal surgery from selected structural and neurologic conditions into prenatal treatment of progressive abdominal, cardiac, pulmonary, and other congenital diseases. 

The achievement illustrates the potential for fetal medicine to shift toward treating patients before birth to prevent irreversible injury rather than waiting for pathology to manifest after delivery.