Adult tracheo-oesophageal fistula (TEF) is a rare entity, with surgical repair serving as the definitive treatment but posing considerable anaesthetic challenges, particularly in airway management. We report the case of a 50-year-old male with a large acquired TEF who underwent myocutaneous muscle flap repair. The patient had previously undergone video-assisted oesophagectomy, complicated by the development of TEF. A self-expanding metal stent was placed in the neo-oesophagus, but it resulted in further erosion and enlargement of the defect. For the definitive repair, awake fibre-optic intubation followed by general anaesthesia and muscle relaxation with invasive monitoring was employed. Although a dedicated enhanced recovery after surgery (ERAS) protocol for TEF repair has not been established, perioperative management in this case was meticulously structured in accordance with standard ERAS principles. This report highlights the pivotal role of a multidisciplinary approach in optimising perioperative care and integrating ERAS-based strategies to enhance recovery following complex TEF repair.
Gautam et al. (2026) studied this question.