The History and Legacy of the Foker Process for the Treatment of Long Gap Esophageal Atresia

jpedsurg.org

Historically, children afflicted with long gap esophageal atresia (LGEA) had few options, either esophageal replacement or a life of gastrostomy feeds. In 1997, John Foker from Minnesota revolutionized the treatment of LGEA. His new procedure focused on “traction-induced growth” when the proximal and distal esophageal segments were too far apart for primary repair. Foker's approach involved placement of pledgeted sutures on both esophageal pouches connected to an externalized traction system which could be serially tightened, allowing for tension-induced esophageal growth and a delayed primary repair.

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Article · Dec 2023 · 1 min read

In brief

This article chronicles the Foker process, a groundbreaking surgical technique introduced in 1997 that uses traction-induced growth to enable primary esophageal repair in long gap esophageal atresia cases. The method transformed treatment options for children who previously faced esophageal replacement or lifelong gastrostomy dependence.

Long gap esophageal atresia historically required esophageal replacement or lifelong gastrostomy feeding before 1997.
The Foker process uses traction-induced growth to lengthen esophageal segments that are too far apart for primary repair.
Pledgeted sutures on both pouches connect to an external traction system that is serially tightened over time.
Tension-induced growth enables delayed primary esophageal anastomosis without need for replacement conduits.

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