Tracheo-gastric fistula is a very rare late complication of total laryngopharyngoesophagectomy with gastric pull-up procedure. It usually occurs after transhiatal esophagectomy, but it has only rarely been reported after total laryngopharyngoesophagectomy with gastric pull-up procedure. Chronic irritation and gastric ulcer may be the cause of tracheogastric fistula. To prevent fistula formation, active management of gastric ulcer and avoidance of mucosal irritation are necessary. We report a case of a tracheogastric fistula which occurred two years after total laryngopharyngoesophagectomy with gastric pull-up procedure that maybe occurred by chronic irritation and gastric ulcer.