Contemporary outcomes of the Foker process and evolution of treatment algorithms for long-gap esophageal atresia.

Document Type

Article

Publication Date

12-2021

Identifier

DOI: 10.1016/j.jpedsurg.2021.02.054

Abstract

BACKGROUND: Esophageal growth using the Foker process (FP) for long-gap esophageal atresia (LGEA) has evolved over time.

METHODS: Contemporary LGEA patients treated from 2014-2020 were compared to historical controls (2005 to <2014).

RESULTS: 102 contemporary LGEA patients (type A 50%, B 18%, C 32%; 36% prior anastomotic attempt; 20 with esophagostomy) underwent either primary repair (n=23), jejunal interposition (JI; n = 14), or Foker process (FP; n = 65; 49 primary [p], 16 rescue [r]). The contemporary p-FP cohort experienced significantly fewer leaks on traction (4% vs 22%), bone fractures (2% vs 22%), anastomotic leak (12% vs 37%), and Foker failure (FP→JI; 0% vs 15%), when compared to historical p-FP patients (n = 27), all p ≤ 0.01. Patients who underwent a completely (n = 11) or partially (n = 11) minimally invasive FP experienced fewer median days paralyzed (0 vs 8 vs 17) and intubated (9 vs 15 vs 25) compared to open FP patients, respectively (all p ≤ 0.03), with equivalent leak rates (18% vs 9% vs 26%, p = 0.47). At one-year post-FP, most patients (62%) are predominantly orally fed.

CONCLUSION: With continued experience and technical refinements, the Foker process has evolved with improved outcomes, less morbidity and maximal esophageal preservation.

Journal Title

Journal of pediatric surgery

Volume

56

Issue

12

First Page

2180

Last Page

2191

MeSH Keywords

Algorithms; Anastomosis, Surgical; Esophageal Atresia; Humans; Retrospective Studies; Treatment Outcome

Keywords

Esophageal atresia; Foker procedure; III; Level of Evidence; Long-gap esophageal atresia; Minimally invasive

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