A 43-year-old man, with no history of smoking, tuberculosis, respiratory diseases or trauma presented with a persistent non-productive cough with mainly postprandial onset with duration of approximately two years. The cough was particularly irrepressible after the intake of fluids. This had resulted in significant weight loss due to reduced food intake. Blood tests at presentation were normal. Computed Tomography (CT) of the thorax showed a hypodense lesion in the right pulmonary lower lobe. Water-soluble contrast radiography of the esophagus showed a broncho-esophageal fistula between the apical segmental bronchus of the lower right lobe and the middle section of the esophagus (Fig. 1a). Bronchoscopy showed a fistula opening that was 4 mm in diameter and approximately 2.5 cm distal to the main carina subsequently confirmed by CT scan 3D rendering (Fig. 1b). Esophagogastroduodenoscopy confirmed a fistula tract ending in the esophageal tract at 30 cm from the incisors. The patient underwent VATS under general anesthesia with selective ventilation and low levels of insufflation pressure in the right lung. The fistula tract was stapled at both ends using an Endo GIA device and excided. The chest tube (24 F placed through lower trocar incision) was removed on the first postoperative day. At the same time, a new esophagography was performed to show any esophageal leakage (Fig. 2). The patient resumed solid food 24 h after the operation. No post-operative complications were observed and there was complete remission of the presenting symptoms. He was discharged in good health on the third postoperative day. Two years after follow-up, there are no apparent complications.