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

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. Despite its potential, the Foker process was received with criticism and disbelief, and to this day, controversy remains regarding its mechanism of action - esophageal growth versus stretch. Nonetheless, early adopters such as Rusty Jennings of Boston embraced Foker's central principle that "one's own esophagus is best" and was instrumental to the implementation and rise in popularity of the Foker process. The downstream effects of this emphasis on esophageal preservation would uncover the need for a focused yet multidisciplinary approach to the many challenges that EA children face beyond "just the esophagus", leading to the first Esophageal and Airway Treatment Center for children. Consequently, the development of new techniques for the multidimensional care of the LGEA child evolved such as the posterior tracheopexy for associated tracheomalacia, the supercharged jejunal interposition, as well as minimally invasive internalized esophageal traction systems. We recognize the work of Foker and Jennings as key catalysts of an era of esophageal preservation and multidisciplinary care of children with EA.

"The Hopkins Mongol Case": The Dawn of the Bioethics Movement.

One of the earliest controversies in the modern history of bioethics was known at the time as "the Hopkins Mongol case," involving an infant with Trisomy 21 and duodenal atresia whose parents declined to consent to surgery. Fluids and feeding were withheld, and the infant died of dehydration after 15 days. The child's short life had a profound impact on the author's career and that of several others and ultimately led to changes in the care of children and adults with disabilities and the way difficult end-of-life decisions are made in US hospitals today. It also contributed to the growth of the modern bioethics movement and scholarship focused on pediatric bioethics issues.

Esophageal atresia, Europe, and the future: BAPS Journal of Pediatric Surgery Lecture.

Europe has changed remarkably over the past decades and so have concepts and outcomes of esophageal atresia repair. In this article, both the efforts to create a united Europe and the achievements in dealing with esophageal atresia from the 1950s on are outlined. Furthermore, this paper deals with the future of pediatric surgery and is focused on two aspects: the "Fourth Industrial Revolution" which builds on the digital revolution, artificial intelligence and robotics, and its potential impact on pediatric surgery and the life of patients. I suggest that pediatric surgeons should participate and lead in the development of machine learning, data control, assuring appropriate use of machines, control misuse, and in particular ensure appropriate maintenance of ethical standards. Changes in health care structures within Europe, in particular the effect of centralization, will affect the concept of treatment for patients with rare diseases.

The Visionaries, the Virtuosos, and the History of Congenital Esophageal Atresia Surgery.

The year 2018 marks the 130th anniversary of the first known surgical attempt at correction of esophageal atresia, performed by Charles Steele. But before the first successful procedure happened, many other surgeons undertook heroic attempts to save newborns and infants with this defect. Two hundred seventy-one years passed from the first description of the defect to the first surgery survivor. This paper presents a fascinating history of these milestones in pediatric surgery and of its pioneers whose creativity, mastery, and fantasy created a basis of congenital esophageal atresia surgery.

Henry Barrett: pioneer paediatric surgeon.

BACKGROUND: Henry Barrett worked as a general surgeon in New Plymouth, New Zealand between 1939 and 1978. In this time, he made significant contributions to the development of paediatric surgery in New Zealand. METHODS: Henry Barrett's archive and personal papers remain in the possession of his family. These described his pioneering operations first hand. RESULTS: In an 18-month period from 1947 to 1948, in New Plymouth small provincial hospital, Henry Barrett successfully completed the first primary repair of an oesophageal atresia with distal tracheoesophageal fistula in the Southern Hemisphere and the second and third successful ligations of patent ductus arteriosus in New Zealand. All three patients survived into adulthood. CONCLUSION: Henry Barrett pioneered the undertaking of two complex paediatric surgical procedures in New Zealand. These operations were performed without specialist paediatric support at a time when procedures for these conditions, particularly patent ductus arteriosus, were viewed with suspicion.

Congenital anomalies of the esophagus.

Normal anatomy, embryology, and congenital anomalies of the esophagus are discussed in this article. The classification, epidemiology, embryology, diagnosis, and management, including outcome following repair of esophageal atresia with or without an associated tracheoesophageal fistula, are described. The diagnosis and management of less common anomalies, such as congenital esophageal stenosis and congenital esophageal duplication, are outlined.

Esophageal atresia. Lessons I have learned in a 40-year experience.

A brief resume of the highlights in the history of oesophageal atresia is presented. This is followed by research into the etiology, ontogeny and embryology, and microbiological studies. A revised classification of risk factors with consequent survival statistics is presented. Lessons learned in the management of the condition over a 40-year period are reported with particular emphasis on the management of the preterm infant with associated severe respiratory distress, right-side aortic arch, upper pouch fistula, 'long-gap' atresia, and the use of gastrostomy and intercostals drains. The incidence and treatment of early and late complications is discussed.

[Historical aspects of oesophageal surgery in pediatric surgical practice].

An attempt is made to explore those aspects of the history of esophageal surgery relevant to pediatric practice. Esophageal artesia is a classic example of the significance pediatric group. Its incidence is about 1/4000. It was first described 1670. Surgical correction was started only in 1920s. The first survivors were reported in 1939. Extrapleural approach was reported in 1941.

[The treatment of oesophageal atresia in The Netherlands]. / De behandeling van oesofagusatresie in Nederland.

The first description of oesophageal atresia dates back to 1670. Oesophageal atresia used to be regarded as a lethal disease, but since the successes of Leven and Ladd in 1939 and Haight in 1941 surgical correction is possible. The Dutch history ofoesophageal atresia begins in 1946. After the successes in America became known, several Dutch surgeons started to treat patients with oesophageal atresia, notably J.ten Kate, L.D.Eerland, M. Schoorl and P.J.Kooreman. In those days, paediatric surgery did not yet exist as a separate specialty. Today, paediatric surgery is concentrated in 6 paediatric surgical centres in the Netherlands. Thanks to the pioneers mentioned and the concentration of knowledge and expertise in the centres, the mortality ofoesophageal atresia patients in the Netherlands has decreased to approximately 9%, despite the fact that currently the gestational age and birth weight of patients is lower and the number of patients with comorbidity is higher.

[The history of the surgery of esophageal atresia (based on data from the Saint-Petersburg Center for Neonatal Surgery)]. / Istoriia khirurgii atrezii pishchevoda (po materialam Sankt-Peterburgskogo tsentra khirurgii novorozhdennykh).

The article presents 42-year experiences with surgical treatment of atresia of the esophagus in 814 neonatals in the St. Petersburg Center of surgery in neonatals. Under analysis are the consecutive periods of work in this field, development and introduction into practice of the methods of surgical interventions, the original Bairov's operation--double esophagostomy--included. Factors responsible for results of the treatment of esophageal atresia are described. Improvement of the methods of treatment has resulted in a possibility mainly to make anastomoses of the esophagus and reduce lethality of neonatals with esophageal atresia from 81 to 7.7%.

Oesophageal atresia: the first survival in the Southern hemisphere.

The first known survival in the Southern hemisphere following a corrective operation for oesophageal atresia, is reported. Contrary to previous reports, this survival was in 1948 not in 1949 and the survival occurred in New Zealand not in Australia.