Recurrent laryngeal neuropathy (RLN, laryngeal hemiplegia, laryngeal paralysis, ‘roaring’) is common in the equine industry with a prevalence ranging from 2.6–11% in light breeds (Raphel 1982; Lane 1987; Morris and Seeherman 1990) up to 38% in draught breeds (Brakenhoff et al. 2006; Perkins et al. 2009). There are a number of different surgical treatments currently available and more being developed. This article aims to discuss factors affecting choice of treatment and then provide an evidence-based approach to describe surgical approaches, success rates and morbidity. Specific details of surgical methods are not given as they are readily available in surgical textbooks (Stick 2006; McGorum et al. 2007).