We report our experience with a one-stage surgery for pediatric cholesteatoma in 216 ears. Our technique is based on three main principles: (1) the surgery is individualized; (2) the goal of surgery is to completely remove cholesteatoma and related disease in one operation; and (3) the reconstruction is performed to provide both good hearing and a dry, trouble-free ear. The incidence of recidivism was 10.2%, and the rate achieved was 13.3% at 5 years and 24% at 10 years. Canal wall down surgery was the predominant procedure used. The incidence of intraoperative neurosensory hearing loss, vertigo, and facial nerve injury was extremely low. The postoperative cavity problems encountered were minimal.