Acquired tracheo-esophageal Fistula (TEF) is a rare but serious complication of prolonged endotracheal intubation. Patients of TEF are usually very critically ill and prone to repeated aspiration and pneumonia. The first stage of treatment involves the diversion of salivary and gastric contents away from the fistula site, improving the nutritional status and control of sepsis. A drainage gastrostomy and feeding jejunostomy is often required to divert the gastric contents away from the fistula and for nutrition. T here are several methods of diversion of gastric contents and for creating feeding jejunostomy including percutaneous, endoscopic, radiological, laparoscopy and laparotomy, tailored according to the clinical situation and the available expertise. In this patient, percutaneous approach alone was not possible due to past and present abdominal surgery and obesity. A combined laparoscopic and endoscopic technique was used to create a drainage gastrostomy and feeding jejunostomy. TEF was repaired three months later.