A recurrent tracheoesophageal fistula is generally associated with considerable mediastinal induration and inflammation. The conventional operative approach may be formidable with considerable blood loss and a high complication rate. For two infants with recurrent fistulae, we have employed a simplified low cervical transtracheal approach through noninflamed tissues. This brief atraumatic procedure was followed by gratifying results. Details of the approach are presented.