CT-guided three-dimensional reconstruction with predictive modeling for personalized esophageal anastomosis in type C esophageal atresia

Background Anastomotic stricture remains the most common and clinically significant complication following primary repair of type C esophageal atresia. Despite various technical modifications, postoperative narrowing at the anastomotic site continues to occur. We describe an approach incorporating preoperative three-dimensional CT reconstruction to enable individualized planning of the esophageal anastomosis. Aims and Objectives To evaluate the feasibility, safety, and early clinical outcomes of a modified esophageal anastomosis guided by preoperative radiological and CT-based measurements in neonates with type C esophageal atresia. Materials and Methods This single-center case series included five consecutive neonates who underwent primary repair between January 2022 and December 2023. Preoperative CT was performed to assess associated anomalies. Multiplanar and 3D reconstructions were used to measure the diameters of the proximal esophageal segment and the distal esophagus at the fistula level. Based on these parameters, a geometry-based calculation was applied preoperatively to determine the optimal length and configuration of the distal esophageal incision to achieve a wider anastomosis. Results On postoperative day 7, contrast esophagography demonstrated a mean anastomotic diameter of 4.71 ± 0.43 mm. One patient developed an anastomotic leak requiring re-thoracotomy and repair. No cases of tracheoesophageal fistula recurrence were observed. During 12 months of follow-up, no patients developed clinically significant anastomotic stricture requiring gastrostomy or repeated dilatation. Conclusion CT-based three-dimensional reconstruction combined with predictive modeling enables individualized incision planning and formation of a wider anastomosis. This approach may reduce postoperative strictures and support patient-specific management of type C esophageal atresia.