This videotape describes the repair of a late complication of tracheal erosion by a gastric staple line. A 51 year old woman underwent a transhiatal esophagectomy for a failed anti-reflux procedure. She did well for 15 months, when she developed hemoptysis from a gastrotracheal fistula. She underwent operative repair with the use of a pericardial patch to replace the membranous trachea and interposition of a latissimus dorsiflap to isolate the stomach from the tracheal suture line. She has done well after this operation with normal barium swallow studies.