Minimally invasive esophagectomy and omental transposition for the treatment of refractory aortoesophageal fistula

Aortoesophageal fistula (AEF) is a rare but frequently fatal condition. Endovascular aortic repair provides rapid hemorrhage control but does not address esophageal pathology, predisposing patients to recurrence and infection. A 48-year-old woman developed recurrent AEF twelve months after thoracic endovascular aortic repair (TEVAR) performed for tuberculosis-related AEF. After failure of conservative management, she underwent a staged procedure consisting of cervical esophageal diversion, substernal gastric conduit reconstruction, robot-assisted esophagectomy, and omental transposition to isolate the aortic stent. Postoperative mediastinal infection occurred and was successfully treated with thoracoscopic debridement. The patient resumed oral intake one month postoperatively. At 12-month follow-up, she remained asymptomatic with no evidence of recurrent fistula, mediastinal infection, or aortic stent graft contamination. In selected patients with refractory AEF after TEVAR, minimally invasive esophagectomy combined with omental transposition may provide effective esophageal control and protection of the aortic stent. Larger studies are required to validate this strategy.