{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T06:04:15Z","timestamp":1789365855763,"version":"build-2803163510"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On postoperative day 7, contrast esophagography demonstrated a mean anastomotic diameter of 4.71 \u00b1 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1871665","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:40:04Z","timestamp":1789364404000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["CT-guided three-dimensional reconstruction with predictive modeling for personalized esophageal anastomosis in type C esophageal atresia"],"prefix":"10.3389","volume":"13","author":[{"given":"Vassiliy","family":"Lozovoy","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Astana Medical University","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenis","family":"Sakuov","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Astana Medical University","place":["Astana, Kazakhstan"]},{"name":"Department of Neonatal Surgery, University Medical Center Corporate Fund","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assylzhan","family":"Yerekeshov","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Astana Medical University","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dastan","family":"Rustemov","sequence":"additional","affiliation":[{"name":"Department of Neonatal Surgery, University Medical Center Corporate Fund","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruslan","family":"Bilal","sequence":"additional","affiliation":[{"name":"Nazarbayev University School of Medicine","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Temirlan","family":"Zhangaskanov","sequence":"additional","affiliation":[{"name":"Department of Neonatal Surgery, University Medical Center Corporate Fund","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zariat","family":"Shatkenova","sequence":"additional","affiliation":[{"name":"Nazarbayev University School of Sciences and Humanities","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1750-1172-2-24","article-title":"Oesophageal atresia","volume":"2","author":"Spitz","year":"2007","journal-title":"Orphanet J Rare Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"120","DOI":"10.3389\/fped.2017.00120","article-title":"Anastomotic strictures after esophageal atresia repair: incidence, investigations, and management, including treatment of refractory and recurrent strictures","volume":"5","author":"Tambucci","year":"2017","journal-title":"Front Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.1016\/j.jpedsurg.2009.11.002","article-title":"Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations","volume":"45","author":"Serhal","year":"2010","journal-title":"J Pediatr Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1016\/j.jpedsurg.2012.04.021","article-title":"A simple technique of oblique anastomosis can prevent stricture formation in primary repair of esophageal atresia","volume":"47","author":"Catalano","year":"2012","journal-title":"J Pediatr Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.jss.2017.04.024","article-title":"Utilizing stricture indices to predict dilation of strictures after esophageal atresia repair","volume":"216","author":"Landisch","year":"2017","journal-title":"J Surg Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1016\/0022-3468(94)90129-5","article-title":"Simple technique for proximal pouch mobilization and circular myotomy in cases of esophageal atresia with tracheoesophageal fistula","volume":"29","author":"Sharma","year":"1994","journal-title":"J Pediatr Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"179","DOI":"10.4103\/ajps.AJPS_123_20","article-title":"A wave-like anastomosis, a new technique of anastomosis to prevent stricture after oesophageal atresia repair","volume":"18","author":"Saiad","year":"2021","journal-title":"Afr J Paediatr Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1007\/s003830100579","article-title":"A new technique of anastomosis to avoid stricture formation in oesophageal atresia","volume":"17","author":"Singh","year":"2001","journal-title":"Pediatr Surg Int"},{"key":"B9","doi-asserted-by":"publisher","first-page":"527323","DOI":"10.1155\/2011\/527323","article-title":"A new technique in primary repair of congenital esophageal atresia preventing anastomotic stricture formation and describing the opening condition of blind pouch: plus (\u201c+\u201d) incision","volume":"2011","author":"Melek","year":"2011","journal-title":"Gastroenterol Res Pract"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.1016\/j.jpedsurg.2013.06.010","article-title":"The role of preoperative CT scan in patients with tracheoesophageal fistula: a review","volume":"48","author":"Garge","year":"2013","journal-title":"J Pediatr Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1007\/s00383-004-1293-5","article-title":"Evaluation of neonates with esophageal atresia using chest CT scan","volume":"20","author":"Ratan","year":"2004","journal-title":"Pediatr Surg Int"},{"key":"B12","doi-asserted-by":"publisher","first-page":"144","DOI":"10.20517\/ais.2022.11","article-title":"The challenges of deep learning in artificial intelligence and autonomous actions in surgery: a literature review","volume":"2","author":"Taher","year":"2022","journal-title":"Art Int Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"4918","DOI":"10.3390\/s22134918","article-title":"The advances in computer vision that are enabling more autonomous actions in surgery: a systematic review of the literature","volume":"22","author":"Gumbs","year":"2022","journal-title":"Sensors (Basel"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1871665\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:40:05Z","timestamp":1789364405000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1871665\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":13,"alternative-id":["10.3389\/fsurg.2026.1871665"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1871665","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]},"article-number":"1871665"}}