Perioperative care of a large left bronchoesophageal fistula complicated by achalasia cardia for video-assisted transthoracic BEF repair: A case report

ABSTRACT This case report details the anesthetic management of a young male in his early thirties presenting with a benign left-sided bronchoesophageal fistula (BEF) secondary to tuberculosis, superimposed upon type 1 achalasia cardia posted for video-assisted thoracoscopic surgery (VATS) transthoracic BEF repair. Gentle intermittent positive pressure ventilation to prevent air leakage through fistula, taking extreme aspiration precautions, and avoidance of positive pressure ventilation postoperatively is key anesthetic considerations. The feasibility of VATS repair for complex fistulas relies entirely on the anesthesiologist’s ability to provide a quiet, collapsed operative field, reinforcing the symbiosis between the surgical and anesthetic teams.