Surgical treatment of laryngotracheal stenosis remains challenging not only because of low case volumes, but also due to highly individualized approaches used, including use of different endoscopic approaches. This article discusses surgical approaches used in 45 patients, including standard cricotracheal resection (CTR) (11 percent), CTR with dorsal mucosal flap (49 percent), CTR with dorsal mucosal flap and lateral cricoplasty (24 percent) and single stage laryngotracheal reconstruction (16 percent). Although, these procedures were carried out with low morbidity, it appears that prior endoscopic approaches add to the complexity of subsequent surgical resection, and adversely affect metrics in functional evaluation. Thus, the authors make a case for earlier surgical referral in patients with laryngotracheal stenosis.