Comparison of Solomon technique with selective laser ablation for twin–twin transfusion syndrome: a systematic review

• Published in: Ultrasound in obstetrics & gynecology 2015-11, Vol.46 (5), p.526-533
• Main Authors: Dhillon, R. K., Hillman, S. C., Pounds, R., Morris, R. K., Kilby, M. D.
• Format: Article
• Language: English
• Subjects: Arteriovenous Anastomosis - embryology; Arteriovenous Anastomosis - surgery; equatorial dichorionization; Female; Fetofetal Transfusion - surgery; Fetoscopy - methods; Humans; laser; Laser Coagulation - instrumentation; Laser Coagulation - methods; Observational Studies as Topic; Placenta - blood supply; Placenta - surgery; Pregnancy; Randomized Controlled Trials as Topic; selective; Solomon; Twins; twin–twin transfusion syndrome
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.14813

ABSTRACT Objective To compare the Solomon and selective techniques for fetoscopic laser ablation (FLA) for the treatment of twin–twin transfusion syndrome (TTTS) in monochorionic–diamniotic twin pregnancies. Methods This was a systematic review conducted in accordance with the PRISMA statement. Electronic searches were performed for relevant citations published from inception to September 2014. Selected studies included pregnancies undergoing FLA for TTTS that reported on recurrence of TTTS, occurrence of twin anemia–polycythemia sequence (TAPS) or survival. Results From 270 possible citations, three studies were included, two cohort studies and one randomized controlled trial (RCT), which directly compared the Solomon and selective techniques for FLA. The odds ratios (OR) of recurrent TTTS when using the Solomon vs the selective technique in the two cohort studies (n = 249) were 0.30 (95% CI, 0.00–4.46) and 0.45 (95% CI, 0.07–2.20). The RCT (n = 274) demonstrated a statistically significant reduction in risk of recurrent TTTS with the Solomon technique (OR, 0.21 (95% CI, 0.04–0.98); P = 0.03). The ORs for the development of TAPS following the Solomon and the selective techniques were 0.20 (95% CI, 0.00–2.46) and 0.61 (95% CI, 0.05–5.53) in the cohort studies and 0.16 (95% CI, 0.05–0.49) in the RCT, with statistically significant differences for the RCT only (P