Tracheoesophageal fistula repair with veno-venous extracorporeal support and Montgomery T-tube: a case report

Tracheoesophageal fistulas (TEFs) are a major surgical challenge requiring a meticulous approach. This case report describes the successful surgical treatment of a 50 mm TEF extending from the upper third of the trachea to 40 mm above the main carina in a young female patient. The chosen strategy involved an extensive transcervical approach, utilization of Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO), and placement of a Montgomery T-tube. The use of ECMO allowed surgical manipulation of mediastinal structures in apnea, ensured adequate gas exchange in the absence of mechanical ventilation, and enhanced comfort during postoperative splinting of the involved structures. The integration of the Montgomery T-tube provided stable airway management postoperatively, particularly advantageous in the context of impaired neurological status precluding early extubation. This combined surgical approach, involving VV-ECMO and Montgomery T-tube, offers a novel, safe, and effective alternative for managing complex TEFs and is recommended for consideration in similar challenging clinical scenarios.