Congenital posterior clefts between the laryngotrachea and the esophagus have rarely been encountered as evidenced by only 30 cases reported in the world literature. Of these, patients in nine have survived. We present another patient with this condition who was successfully treated. Important aspects in evaluation, including the need for an experienced endoscopist and cineradiography, are discussed. Postoperative management using a continuous infusion pump to administer formula per gastrostomy prevents gastric distension and emesis that lead to stress on the closure. This should be a basic consideration in the management of these patients.