Esophagectomy in aquired tof(tracheoesophageal fistula)

25 yrs old patient took sulphos accidentally 9 months back and developed stricture and tracheoesophageal fistula just above the Carina.He was treated with a covered self expanding metallic esophageal stent (SEMS).His pneumonia improved but fistula did not close and he started having disphagia (difficulty in swallowing).He was taken up for surgery. Esophagectomy stent removal & closure of tracheal defect and gastric pull up forming neo esophagus was done.

Tracheoesophageal fistula with stent in situ

• Stomach mobilized on right gastro epiploic vessels. Complete Kocherisation done along with pyloric dilatation to pull the stomach tube at the apex of chest.

• Mediastinal dissection close to the esophagus to mobilize it below the fistula

• SELF EXPANDING METALLIC STENT(SEMS)

• FULLY COVERED 12CM LONG.

• Esophagotomy done to Lay open the fistula site.

• Suture(4/0 pds double arm )taken around the fistula on the tracheal ring and on the anterior esophageal flap.

• Double lumen endotracheal tube going to left bronchus.

• Tracheal baloon at the Carina is presenting.

• Fistula closed in two layers over Tachosil Patch.

• Stomach tube taken in the chest and anastomosed with the esophagus at the apex of chest.