Foker Process | What to Expect

The Foker process works best when used as the initial treatment for long-gap esophageal atresia. It can sometimes be used after other treatments, such as colonic interposition or a gastric pull-up, have failed, but experience has shown that this is not ideal.

At Boston Children's Hospital, we can perform the Foker process on newborns and children who weigh as little as 7 pounds. The process takes anywhere from several weeks to several months to complete, depending on the severity of your child's condition. Because the process allows your child grow their own esophagus, surgically transplanting other parts of the digestive tract (such as the colon or stomach) is not necessary. This approach may also reduce the risk of infection, eating difficulties and malnutrition.

What happens during the Foker process?

With your child fully sedated, the surgeon will make an incision on the back of their chest. Unlike traditional treatments, which require large incisions on the abdomen as well as the neck and chest, the Foker process results in fewer incisions and smaller scars.

The surgeon will then place four or five sutures (stiches) on the upper and lower ends of your child's esophagus. These are tiny stitches that connect the ends to the outside. The tension on the sutures will be increased bit by bit, causing each end of the esophagus to grow about one to two millimeters each day - just like a muscle grows when you exercise it. This will create just enough growth for the two ends to be attached. Depending on how much your baby's esophagus needs to grow, this typically may take between one and three weeks.

For the Foker process to be successful, your baby will need to be motionless during the time the esophagus is being stretched, because excessive motion might pull out the sutures. Medication will be provided to keep your child still. During this time, your child will stay in the intensive care unit on a ventilator (breathing machine). Once the esophagus has grown to the desired length, the surgeon will remove the sutures and sew together the ends of the esophagus. This extraordinary procedure often results in an esophagus that is indistinguishable from one that has developed normally on esophagrams.

Depending on your child's unique situation, we also offer minimally invasive versions of the Foker process that do not require full anesthesia.

What happens after the Foker process?

Typically your child will be able to eat normally fairly soon after the surgery. Your child may need to be monitored for strictures (places of narrowing) in the esophagus, but these are treatable and in general, the outlook is very good. Almost all of the patients treated with this method to date are able to eat and swallow. Our doctors will continue to evaluate your child every year or two throughout childhood to make sure that there are no problems or complications.