title: Is fundoplication required after the Foker procedure for long gap esophageal atresia?
abstract: BACKGROUND
  Fundoplication has been performed almost universally in children treated with the Foker procedure (FP) for long gap esophageal atresia (LGEA). We report our experience with pharmacological management and endoscopic surveillance rather than early routine fundoplication in infants treated with the FP.
  
  
  METHODS
  A retrospective chart review was performed of all children treated with the Foker procedure at our institution.
  
  
  RESULTS
  Nine children have undergone the FP since 2007. Median time between FP and definitive anastomoses was 22days. All nine children kept their native esophagus. There were three minor anastomotic leaks, all treated nonoperatively. All children required dilatation of anastomotic strictures (range 2-15). All have been treated with proton pump inhibitors. Three children had eosinophilic esophagitis and one had Barrett's esophagus. Only two children in this series have undergone fundoplication, which was performed for symptomatic and persistent erosive esophagitis.
  
  
  CONCLUSIONS
  The question of early versus delayed fundoplication in LGEA patients managed with the FP remains unanswered. Our series demonstrates that it is possible to achieve good long-term outcomes when the operation is reserved for children with gastroesophageal reflux disease resistant to maximal medical therapy.
  
  
  METHODS
  IV.
authors.affiliation: The Toby Bowring Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, Australia. Electronic address: d.wanaguru@yahoo.com.au.
authors.forename: Dylan
authors.initials: D
authors.lastname: Wanaguru
authors.affiliation: The Toby Bowring Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Langusch
authors.affiliation: Department of Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, Australia.
authors.forename: Usha
authors.initials: U
authors.lastname: Krishnan
authors.affiliation: The Toby Bowring Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Varjavandi
authors.affiliation: The Toby Bowring Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, Australia.
authors.forename: Ashish
authors.initials: A
authors.lastname: Jiwane
authors.affiliation: The Toby Bowring Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Adams
authors.affiliation: The Toby Bowring Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, Australia.
authors.forename: Guy
authors.initials: G
authors.lastname: Henry
mesh_terms: D002675:Child, Preschool; D004933:Esophageal Atresia / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy / Q000601:surgery*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors
keywords: Foker; Fundoplication; Long gap esophageal atresia