The FETO Procedure

The procedure is divided into two phases:

1. Balloon Insertion (Occlusion): Performed between 27 and 29 weeks of pregnancy. A tiny balloon is placed in the windpipe to start the growth phase.
2. Balloon Removal (Reversal): Performed around 34 weeks. The balloon is removed to allow the lungs to 'deflate' slightly and prepare for the baby's first breath at birth.

The goal is not to fix the hole in the diaphragm (which is done after birth), but to ensure the baby has enough lung volume to breathe while the surgeons work.

FETO is only recommended for babies with 'severe' or 'moderate-to-severe' CDH, determined by the O/E LHR (Lung-to-Head Ratio).

If the ratio is below 25-30% on the left side (or lower on the right), the risk of the baby not surviving at birth due to small lungs is very high. In these specific cases, FETO can nearly double the chances of survival.

Before the procedure, several checks are essential:

1. Fetoscopic Planning: Mapping the location of the baby's face and the safest entry point into the amniotic sac.
2. Balloon Selection: We use a 'Goldbal'—a microscopic latex balloon that is filled with saline.
3. Maternal Preparation: The mother is given a course of steroids to help mature the baby's lungs and reduce the risk of premature delivery.

The insertion procedure is performed under local anesthesia and sedation:

• Entry: A thin tube (trocar) is passed through the mother's abdomen into the amniotic fluid.
• Navigating the Airway: Using a 1.2mm fetoscope (like a tiny camera), the surgeon navigates through the baby's mouth and vocal cords into the trachea.
• Inflation: The balloon is inflated inside the trachea and detached. The entire process is visible on a high-definition screen.
• Balloon Removal: This is equally important and can be done fetoscopically, via a small needle puncture (ultrasound-guided), or in an emergency at birth (EXIT procedure).

The results of FETO have been validated by global clinical trials (the TOTAL trial).

• Survival: For severe left-sided CDH, survival increases from approximately 15% without surgery to 40-50% with FETO.
• Lung Function: Babies who have had FETO typically have larger lungs and a lower requirement for ECMO (heart-lung bypass) after birth.
• Long-term: While FETO helps the lungs grow, these babies still require expert neonatal and surgical care after birth.

Referral for FETO must be timely. The ideal window for assessment is between 24 and 26 weeks, as the surgery must be performed by 29 weeks to be most effective.

Our Unit provides a rapid-response triage for CDH diagnosis. Families meet with our fetal surgeons and pediatric surgical partners to discuss the technical aspects and the postnatal roadmap. Dr. Werner Diehl's fellowship training at leading European centers ensures that our techniques match the highest global benchmarks.