OBJECTIVE: Prenatal repair of open spina bifida has become well-established. Several surgical approaches have emerged, each focused on optimizing outcomes while minimizing risks. This study aims to compare the gestational age at delivery following the various surgical techniques. DATA SOURCES: This systematic review and meta-analysis synthesizes data from 37 studies between 2010 and 2023. STUDY ELIGIBILITY CRITERIA: Eligible studies included pregnant patients diagnosed with open spina bifida who underwent the following intrauterine repair techniques: open, mini-hysterotomy, laparotomy-assisted fetoscopic, and percutaneous fetoscopic repair. STUDY APPRAISAL AND SYNTHESIS METHODS: The primary outcome investigated was gestational age (GA) at delivery, while secondary outcomes were preterm premature rupture of membranes (PPROM), vaginal birth, and perinatal mortality. The programming language software R (version 4.0.5) was used to execute the analysis. RESULTS: In this meta-analysis, 2,333 prenatal repair of open spina bifida procedures arising from 14 countries were analyzed. Of these, open repair accounted for 65.7%, mini-hysterotomy 14.4%, laparotomy-assisted fetoscopic 5.36%, and percutaneous fetoscopic 14.6%. Subgroup analyses revealed a non-significant mean GA at birth:34 CONCLUSIONS: The advanced secondary Bayesian analysis of data from this meta-analysis suggests that the mean gestational age at birth may differ among the four surgical techniques for prenatal repair of open spina bifida, with a potential advantage for the decrease in preterm births associated with a laparotomy-assisted approach. However, these findings should be interpreted cautiously, and further direct comparison studies are needed to confirm these observations.