Tubeless Surgery for Adult Congenital Tracheoesophageal Fistula at Fujian Medical University Union Hospital
Tubeless Surgery for Adult Congenital Tracheoesophageal Fistula at Fujian Medical University Union Hospital
Fujian Medical University Union Hospital recently reported a complex case of adult congenital tracheoesophageal fistula treated with a tubeless surgical strategy. The procedure was performed by Dr. Guobing Xu’s thoracic surgery team in collaboration with anesthesiology and endoscopy specialists.
This case highlights the clinical value of tubeless, spontaneous-ventilation anesthesia in complex airway–esophageal reconstruction. Rather than simply avoiding endotracheal intubation, the approach was used to improve surgical exposure, reduce airway interference, and support postoperative recovery.
Patient Background
The patient had experienced coughing after eating since childhood and had long been unable to tolerate hot water or spicy food. Recently, the symptoms worsened, with recurrent aspiration pneumonia, hemoptysis, chest tightness, and shortness of breath.
Further evaluation with chest CT, gastroscopy, and bronchoscopy identified an abnormal communication between the esophagus and trachea. The patient was diagnosed with congenital tracheoesophageal fistula.
Adult congenital tracheoesophageal fistula is uncommon. Because symptoms may present as chronic coughing, meal-related choking, recurrent pulmonary infection, or unexplained hemoptysis, diagnosis can often be delayed. For patients with persistent coughing after meals or recurrent aspiration pneumonia, an airway–esophageal abnormality should be considered.
Why Tubeless Surgery Was Selected
The key treatment goal in tracheoesophageal fistula is to completely remove the fistulous tract, repair the tracheal and esophageal structures, and prevent esophageal contents from entering the airway.
Conventional surgery under endotracheal general anesthesia is a standard option. However, in airway–esophageal fistula repair, the endotracheal tube and cuff may affect exposure of the tracheal opening and interfere with delicate tracheal-side reconstruction.
In this case, the tubeless strategy allowed the patient to maintain spontaneous breathing without an endotracheal tube in the operative field. This provided a clearer surgical view and more working space for fistula resection, tracheal management, and layered esophageal repair.
Surgical Process and Multidisciplinary Collaboration
During the operation, the patient maintained spontaneous ventilation without endotracheal intubation. The thoracic surgery team performed fistula resection, tracheal-side management, and layered repair of the esophageal wall.
Gastroscopy and bronchoscopy were used in real time to locate the fistula, monitor both the airway and esophageal sides, and help assess the integrity of the repair.
The technical challenge in this type of surgery is not only removing the fistula, but also safely reconstructing both the respiratory and digestive tracts. Successful treatment requires close coordination among thoracic surgery, anesthesiology, and endoscopy teams.
Postoperative Recovery and Clinical Significance
After surgery, the patient recovered smoothly. Follow-up showed improvement in meal-related coughing and hemoptysis, gradual resolution of pulmonary inflammation, and better feeding tolerance.
This case demonstrates the potential value of tubeless surgery in selected complex thoracic procedures. By avoiding airway instrumentation in the operative field, the technique may help improve exposure, reduce intubation-related irritation, and support enhanced recovery.
Tubeless surgery is not simply the pursuit of “no tube.” It requires careful patient selection, experienced anesthesia management, continuous intraoperative monitoring, and a clear airway rescue plan. In appropriate cases, it may provide a less invasive pathway for complex airway–esophageal reconstruction.
