title: Foker Technique for the Management of Pure Esophageal Atresia: Long-Term Outcomes at a Single Institution.
abstract: BACKGROUND
  We present the short- and long-term outcomes in the management of pure long-gap esophageal atresia (LGEA) using the Foker technique (FT) of esophageal elongation by external axial traction at a single institution.
  
  
  METHODS
  All patients undergoing esophageal atresia (EA) repair with FT over a 10-year period were included in the study. Demographic data, birth weight, gestational age, associated anomalies, management, and short- and long-term outcomes were studied.
  
  
  RESULTS
  Five patients (three males) were treated with FT in the study period, all with LGEA, with a mean birth weight of 1,926 g (range, 541-2,890 g). Four infants had associated anomalies. Primary repair after FT axial traction was achieved in four patients after a mean traction time of 13 days (range, 12-15 days). FT failed in one patient who had esophageal perforation from traumatic orogastric tube placement at birth and extensive matting of the esophagus at the time of FT attempt. The mean age at definitive esophageal anastomosis was 11.5 weeks (range, 8-14 weeks). In three of the five patients, traction sutures from the distal esophageal segment tore away, requiring a thoracotomy for replacement. One of the four patients had a confined leak at the anastomosis. All four patients developed strictures at the anastomosis, requiring serial dilations (mean 12 dilations, range 6-21 dilations), and three of those patients underwent a thoracotomy for stricture resection (two patients) or stricturoplasty (one patient). On long-term follow-up, all patients in whom a primary anastomosis was achieved had their gastrostomy closed and were on full oral feeds.
  
  
  CONCLUSIONS
  FT was successful in achieving a primary anastomosis in 80% of the patients with LGEA, with a significant morbidity but favorable long-term outcomes.
authors.affiliation: Department of General Surgery, University Hospital Case Medical Center, Cleveland, Ohio, United States.
authors.forename: Iuliana Dit
authors.initials: ID
authors.lastname: Bobanga
authors.affiliation: Department of Pediatric Surgery, University Hospital Case Medical Center, Ohio, United States.
authors.forename: Edward Metz
authors.initials: EM
authors.lastname: Barksdale
mesh_terms: D000714:Anastomosis, Surgical; D015897:Comorbidity; D004933:Esophageal Atresia / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013908:Thoracotomy; D016896:Treatment Outcome