This 20-year, dual-institution retrospective study compares outcomes between simple ligamentum division and Kommerell diverticulum (KD) resection with left subclavian artery transfer in patients undergoing surgical correction of vascular rings. While both approaches were associated with excellent outcomes and low complication rates, KD resection showed a lower incidence of recurrent symptoms and no need for reoperation in the resection group. The study found no increased perioperative morbidity associated with KD resection, suggesting it may be a safe and effective strategy in select patients. These findings support consideration of KD resection with arterial translocation as a more definitive approach for reducing long-term complications in vascular ring surgery.