A MODIFIED ESOPHAGEAL ANASTOMOTIC TECHNIQUE BASED ON THREE-DIMENSIONAL CT RECONSTRUCTION IN TYPE C ESOPHAGEAL ATRESIA

Zhenis Sakuov, Vassiliy Lozovoy, Asylzhan Erekeshov, Dastan Rustemov, Ruslan Bilal, Nurzhan Zheldybayev

2026

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DOI 10.35805/bsk2026ii005
Data confidence 70 medium
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Abstract

Background. Anastomotic stricture remains the most common complication after repair of esophageal atresia. Despite technical modifications, the risk of postoperative narrowing persists. This study presents an approach integrating three-dimensional computed tomography reconstruction into preoperative planning to enable mathematical calculation of incision parameters for a wider anastomosis.The aim isevaluating the efficacy and safety of a computed tomography-guided modified esophageal anastomotic technique compared with conventional end-to-end anastomosis. Materials and Methods. A two-center study (2022–2024) included 27 neonates with type C esophageal atresia. Group A (n = 13) underwent computed tomography-guided modified anastomosis, while Group B (n = 14) received standard end-to-end anastomosis. All patients underwent preoperative contrast esophagography. In Group A, three-dimensional computed tomography reconstruction was used to measure proximal (D1) and distal (D2) esophageal diameters and calculate incision length. On postoperative day 7, anastomotic diameter (D3) was measured. Outcomes included leakage, the tracheoesophageal fistula recurrence, and stricture requiring gastrostomy. Results. Anastomotic diameter (D3) was significantly greater in Group A than in Group B (p< 0.005). One anastomotic leak occurred in Group A. No leaks were observed in Group B; however, four patients developed strictures requiring gastrostomy. Conclusion. Computed tomography-based three-dimensionalreconstruction with predictive modeling enables formation of a wider anastomosis and may reduce postoperative strictures and the need for dilatation, supporting a personalized approach to esophageal atresia repair.