Foker Process

What is the Foker process?

The Foker process is an innovative procedure that is used to treat some forms of esophageal atresia. In this rare birth defect, a baby is born without part of the esophagus (the tube that connects that mouth to the stomach).

Until recently, there were no satisfactory treatment options for long-gap esophageal atresia to save the esophagus. The approach to this condition usually involves surgery to connect the ends of the esophagus together without stretching them. For a child with the more challenging form of esophageal atresia known as long-gap esophageal atresia, however, the gap between the two "nubs" of the esophagus is too far apart to connect surgically.

John Foker, MD, PhD, a pediatric, general and cardiac surgeon from the University of Minnesota, developed a technique to stimulate growth of the upper and lower ends of the esophagus to treat cases of long-gap esophageal atresia. This technique, known as the Foker process, is a revolutionary procedure that encourages natural growth and strengthening of a child's existing esophagus, resulting in an esophagus that works so well that it is often nearly indistinguishable from one that developed normally.

Since 2009, Dr. Foker has worked exclusively with Boston Children's Hospital surgeon Russell Jennings, MD, and the Esophageal and Airway Treatment Center team to ensure that his surgical technique continues to help young patients with esophageal concerns. We have the most extensive experience in the world in performing the Foker process, with outcomes data to support its benefits. Our published results show a clear difference in outcomes between children treated initially at Boston Children's and those who come to us for repair after a surgical procedure performed elsewhere.

Data shows that children who undergo the Foker process at Boston Children's experience:

  • Fewer hospitalization days
  • Less time on mechanical ventilation
  • More success eating entirely by mouth
  • Fewer required surgical procedures

What is the minimally invasive Foker process?

For some children, a new minimally invasive version of the Foker process may be an option. As its name implies, the minimally invasive Foker process involves very small incisions on your child’s back and uses minimally invasive instruments and a camera. The surgeon places traction sutures on each end of the esophagus but creates the traction system inside your child’s body by securing the sutures around one of their ribs. Surgeons tighten these sutures every week until the two ends of the esophagus are close enough to attach to each other.

Because the risk of tearing or breaking the traction system is reduced, your child won’t need to be kept asleep and still. Preliminary results show that the minimally invasive approach is as safe and effective as the traditional Foker process, but requires less time spent in the ICU and fewer pain medications and sedatives. Your surgeon can tell you more about this possible option.