Esophageal Atresia Treatment Program
The Foker Process
About the procedure
The EAT Program at Boston Children's is the only center in the world dedicated to using a highly advanced surgical technique, known as the Foker process, to treat cases of long-gap esophageal atresia (EA), and related problems such as extensive strictures in the esophagus or esophageal leaks following prior surgery.
Using the Foker process, our surgeons place small sutures in the disconnected or damaged ends of the esophagus and add small amounts of tension to those sutures daily. Over time, the tension stimulates the esophageal ends to grow longer and the two ends eventually grow closer together. The ends are then surgically connected to restore esophageal continuity. Though the esophageal muscle may not contract normally, the native esophagus may serve a child better long term than other organs or parts of organs that are sometimes used to replace the esophagus, such as the stomach, intestine or colon.
For the Foker process to be successful, patients need to be motionless during the time the esophagus is being stretched, because excessive motion might pull out the sutures. This requires the infants or children be given medications to keep them still. During this time, they stay in the intensive care unit on a ventilator (breathing machine). Repeat cases, in which the esophageal ends may take much longer to stretch, can require children to be sedated and motionless for weeks or months, giving the esophagus ends time to grow. It is not fully understood at this time whether such prolonged sedation has any long-term adverse impact on the infants and children. We know that decreased motion does make the bones weaker and more susceptible to fractures.
The Foker process can be performed on children as small as 7 pounds (3.5 kg), and it takes anywhere from several weeks to several months to complete, depending on the severity of the condition. Because the process allows the patient to grow his/her own esophagus, surgically transplanting other parts of the digestive tract, like the colon, is unneeded. This approach may also reduce the risk of infection, eating difficulties and malnutrition.
Unlike traditional treatments, which require large incisions on the abdomen as well as the neck and chest, the Foker process is done through an opening on the right side of the chest, which means that patients end up with fewer and smaller scars. Although repeated entries into the chest may increase the risk of scoliosis (curvature of the spine) in some children as they grow.
Finding the proper treatment to address your child's long-gap EA will depend on many factors. As is the case with all surgeries, many variables must be taken into consideration before a treatment plan is finalized; and as a parent, you will play a vital role in making those decisions. If you are weighing treatment options for your child with long-gap EA we encourage you to speak with a medical professional who can clearly explain all the options to you. For further details about how long-gap EA is treated at Boston Children's, we invite you to call 617-355-3529 and speak with one of our experts.