Abstract Experience with thirty-eight cases of congenital tracheoesophageal fistula is reviewed. Fifty-four major complications developed in thirty-six patients. The two patients without problems had a high H type of fistula, one of which was repaired through the neck, and the other repaired through the chest. The complications are discussed in detail as to predisposition, recognition, and management. The most frequent problems are respiratory distress syndrome (ten of thirty-eight patients), postoperative esophageal stricture (eight of thirty-eight), pneumothorax, often from tracheal leak rather than esophageal leak (seven of thirty-eight), congenital heart disease and heart failure (five of thirty-eight), congenital malformation of the abdominal alimentary tract (four of thirty-eight), recurrent tracheoesophageal fistula (five of thirty-eight), empyema and mediastinitis (four of thirty-eight). Only sixty-four cases of recurrent tracheoesophageal fistula have been reported in the literature. The problem may be more common (it occurred in 13 per cent in our series), and emphasis is placed on suspicion and diagnostic methods. Single complications included infarction of the right upper lobe, hyperbilirubinemia in a neonate, foreign bodies in an esophageal diverticulum, abscess with right middle lobe consolidation from a retained loop of umbilical tape, obstruction from sequestering intraluminal tracheal sutures, and evisceration through a gastrostomy incision. The prematurity rate was 15 per cent (five of fiftythree). The mortality rate was 39 per cent (thirteen of thirty-three). However, more than half of the deaths (seven patients) occurred during the first three years of our experience, that is, from 1953 to 1956.