Esophageal Atresia Treatment Program

The Foker process

In the majority of cases of esophageal atresia, joining the ends of the esophagus is straightforward. In some children, however, the ends are so far apart they cannot be easily connected.

To solve the problem, John Foker, MD, a pediatric surgeon from the University of Minnesota, developed a technique to stimulate the upper and lower ends of the esophagus to grow so they could be joined together.

How does it work?

Using the Foker process, surgeons place traction sutures in the tiny esophageal ends and increase the tension on these sutures daily until the ends are close enough to be sewn together. Click the illustration to the right.

How long does it take to grow "new" esophagus?

Occasionally, when the gap is not overly long, the traction sutures will stimulate enough esophageal growth relatively rapidly. When this happens, the traction sutures are placed internally. After 2 to 3 days time, the incision is reopened and the esophageal ends are sewn together.

How long does growth take for children with long-gap EA?

For the very longest gap infants, more time is needed. In these children, the traction sutures are placed in the esophageal ends and brought through the skin to the outside of the chest wall. These children are kept on a ventilator and heavily sedated so they do not tear the traction sutures loose. When the ends are close enough together, the child is returned to the operating room and the esophagus is joined.

The good news is even the very longest gaps rapidly respond to growth stimulus.

How many surgeries can we expect?

At least two operations are required: one to establish the sutures that will apply the tension, and one to join together the grown esophageal segments. One or two additional operations may be required during growth, to re-establish suture lines or modify the direction of growth. The entire process takes two to three weeks.

When will my child be able to eat normal foods?

Over a span of three to six months, children will learn how to eat solid food orally.