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.

1. 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.

3. Tracheoesophageal fistula with stent in situ

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

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

9. • SELF EXPANDING
METALLIC
STENT(SEMS)
• FULLY COVERED
12CM LONG.

10. • Esophagotomy done
to Lay open the
fistula site.

11. • 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.

12. • Fistula closed in two
layers over Tachosil
Patch.

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