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The length of time it takes to grow the esophagus depends on the length of the gap, whether there have been past operations, and the presence of other medical conditions or problems.
In cases where the Foker process is the first form of treatment, the average duration to repair of the esophagus was 16 days (the range was six to 34 days). For children with prior attempts at repair, it was 31 days (the range was eight to 57). If the connection leaks or narrows, additional procedures may be necessary, sometimes substantially lengthening hospitalization. During this stretching phase, your child will be kept on a ventilator. He or she will be heavily sedated and often motionless, so the traction sutures do not tear.
The esophagus will grow an average of 1 to 2 millimeters per day on each end. When the ends are close enough together, your child is returned to the operating room and the esophagus is repaired. Even the very longest gaps respond to growth stimulus, so a child with a very long gap can expect to be connected.
If the gap is too long for a primary esophageal repair, the Foker process is appropriate. The Foker process is based on growing each end of the esophagus so that a primary anastomosis can be performed.
If the Foker process is not ideal, you child’s EA/TEF may be treated using a jejunal interposition. In Jejunal Interposition, our surgeons will use a section of the jejunum (the middle part of the small intestine) as a replacement for the missing section of esophagus.
This works because the jejunum is thin enough to be placed behind the trachea, just like the esophagus. It also doesn't dilate or "kink" like a transposed colon segment might, so no surgical revisions are required.
The number of operations required to repair a long-gap EA is directly related to whether this is the first attempt at repair, or whether surgery has been performed prior to the infant coming to Boston Children’s Hospital. At a minimum, two operations are required:
Once the sutures are in place, other surgeries may still be required to:
If the two ends of the esophagus can be connected, there may be further surgeries required after this point to repair esophageal leaks or to remove sections of the esophagus that have become severely narrowed with scar tissue.
Also, your child may require an operation for gastroesophageal reflux (backflow of gastric contents up into the esophagus), called a Nissen fundoplication. In this procedure the upper part of the stomach is wrapped around the lower end of the esophagus and stitched in place to provide resistance to gastric contents flowing up into the esophagus. This surgery is needed because the lower portion of the esophagus in infants and children born with EA does not have the normal muscle movements (peristalsis) to push fluids and food down the esophagus into the stomach.
If your child has long-gap esophageal atresia and may require the Foker process or growth induction, the success rate for esophageal continuity is lower in children who have had previous operations.
Our patients usually learn how to eat by mouth over the course of three to six months. Our goal is for the children to begin eating as soon as possible. Our team works together with our feeding specialist to develop a plan based on your child’s individual needs.
Typically, eating by mouth appears to be a natural instinct until approximately 2 to 3 months of age. But if a child has not been able to take food by mouth during this period, learning to do so can pose a challenge. Many of our patients require the use of a gastrostomy tube for nutrition, which can decrease their motivation and drive to eat.
Lack of eating and other experiences can lead to a feeding or oral aversion, a response that may vary based on each child’s development, past history and therapies. Each of these experiences can provide a negative or positive impact and affect a child’s ability or drive to eat.
The majority of our patients come from around the country and the world. They come in order to receive the highly specialized care we offer for children with esophageal and airway problems. We have helped families plan their trip, obtain insurance approval and find helpful resources.
Yes, we are happy to arrange a phone consultation so you can ask questions and talk about a surgical plan for your child.
Since most of our patients come from far away, we are very familiar with various insurance companies. We will help walk you through the process, and provide any information your insurance company may require.
Unfortunately, the exact amount of time is based on each child’s individual needs. We can provide an estimated time for you, though, based on our treatment plan.
To make an appointment or speak with a member of our team, please call 617-355-3038.
For families residing outside of the United States, please call Boston Children's International Health Services at +01-617-355-5209.
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