Foker procedure utilizes transthoracic traction of both proximal and distal ends of the esophagus with external fixation of the esophageal sutures that will allow successive instillation of "spacers" to increase stretch on the sutures in an attempt over a long period of time to approximate the ends allowing anastomosis and establishing continuity of the esophagus.
Used once in infant with Down's syndrome. Eventually, lower sutures pulled through but enough stretch on distal esophagus to allow anastomosis during thoracototmy. Currently with slowly healing anastomotic leak. Will assess in two weeks.
I have seen it performed by Maria Francelina Lopes (also registered here in Researchgate, you could ask her for current modifications) and it worked in several cases in 2003-2004. She kept contact with Foker himself along the procedures, All traction sutures for each pouch (terminal or distal) were grouped in a single strand. The two resulting strands (proximal and distal) were exteriorized through two small foamy, spongious plates on the surface of the skin to prevent direct pressure and erosion. The traction was performed by patiently inserting a vascular clip a day on each end to achieve almost a 2 mm reduction of the whole gap per day. Afterwards, I have visited other institutions that swear the procedure was a terrible mistake but I did not see their technique. I guess it is a real matter of finesse and patience.
I tried once. All sutures are tired. It is failed.
We always prefer Immediately Primary Anastomosis with/without Livaditis myotomies for all isolated esophageal atresia. We achieved in all cases.
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