PAAFIS started as a concept in 2012, when a pediatric gastroenterologist and surgeon were discussing medically complex patient on foregut issues. It was at that moment that we realized how often we were lacking an adequate and timely input from various specialties in challenging cases. We decided to create a model were a collective approach would be used to optimize medical decision making, bringing together those interested with leading experts from medical and surgical fields across continents. We incorporated their knowledge, expertise, skills and will to advance abilities of local and international medical and surgical communities through conferences, hands-on courses, live case discussions and collaboration in trans-institutional research.