OBJECTIVETo determine the outcome of laryngotracheal separation (LTS) in 60 patients in terms of the control and prevention of severe and persistent aspiration, morbidity and mortality, reversibility rate, and the influence of the presence of a tracheostomy.STUDY DESIGNRetrospective study.RESULTSLTS showed significant efficacy rates in terms of both treatment (87%) and prevention (100%) of pulmonary aspiration. Twenty‐six (43%) patients developed postoperative complications. A tracheocutaneous fistula of the proximal tracheal stump was observed in 14 (23%) patients and was the most frequent complication, especially in patients with a therapeutic indication (P = 0.028) and in those with a tracheostomy (P = 0.058). Reversion of LTS was possible in 12 (20%) patients, mainly those with a prophylactic indication (P = 0.005). However, the rates of complications (58%) and inefficacy (27%) of reversion surgery were high.CONCLUSIONLTS is effective in the elimination and prevention of clinically intractable aspiration. The procedure is potentially reversible. However, the frequency of complications for both LTS and reversion surgery is significant.