This video, featuring experts from Cincinnati Children's, discusses the challenging management of recurrent tracheoesophageal fistula (TEF) years after initial repair. Dr. Douglas von Allmen presents a clinical scenario and highlights the risk of recurrent laryngeal nerve (RLN) injury during re-repair. The episode emphasizes a transtracheal approach to improve surgical exposure and minimize potential harm to the RLN, thereby reducing long-term voice and aspiration issues.