Foker Process

Also known as: long-gap esophageal atresia surgery, pure esophageal atresia surgery

What is Foker process?

Esophageal atresia is a birth defect that causes disruption of the esophagus, so it does not connect properly to the stomach. If the ends of the esophagus are far apart, it is often difficult to treat. In the past, it took months for the two ends to grow close enough to connect. The Foker operation is a modern set of procedures that can successfully treat even the trickiest forms of esophageal atresia in days to weeks instead.

What happens during the procedure?

  • The child is fully asleep, and a surgeon makes an incision in side of the child’s right chest.
  • The upper and lower ends of the disconnected esophagus are identified.
  • Several long tacking sutures are place in both of the ends of the esophagus.
  • These sutures actually exit the chest wall above and below the wound, which is closed in the usual way.
  • Over the coming days, the child lies motionless using a breathing machine, while the sutures are gently tightened on the outside of the body to stretch the esophagus.
  • This process gradually lengthens the esophagus until the upper and lower ends meet, at which point, the surgeon will connect the two ends together.

Is any special preparation needed?

Since esophageal atresia is often accompanied by other defects, in the anus, heart, spine, kidneys or limbs, studies must be done to identify or rule out these problems.

What are the risk factors?

Bleeding, infection, pain, damage to the esophagus, leak of the repair, pneumonia, nerve damage and other complications are possible. 

What is the recovery like?

Most of these children will have the definitive repair of the esophagus one to two weeks after the first operation to put in the stretching stitches.  Occasionally the stretching stitches will pull out of the end of the esophagus, and a repeat of the first procedure to replace them will be advisable.  It may take a month or so after the reconstruction of the esophagus to eat normally or to allow a leak, which almost always heals without surgery, to heal. That said, most of these children will live normal lives once they recover from the surgery.

Reviewed by: Cathy Anne Burnweit, MD

This page was last updated on: April 22, 2021 02:00 PM

Pediatric Gastroenterology

The Division of Pediatric Gastroenterology at Nicklaus Children’s Hospital is dedicated to the treatment of a wide variety of gastrointestinal problems in infants, children and adolescents with a multidisciplinary approach.

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