Esophageal anomalies present a challenge to the pediatric surgeon and demand close attention and care from the nursing staff as well as the surgical staff. We have encountered a survival rate of 96 per cent for all infants undergoing operation for esophageal atresia. An emergency gastrostomy is recommended as an immediate procedure when the diagnosis is established. In many instances, it can be performed with local anesthesia if the infant is particularly small or has developed aspiration pneumonia. The definitive operation is delayed until the infant is in optimum condition to permit a general anesthetic and thoracotomy. Staging is recommended for all infants with a birth weight of less than 2000 gm. Once the infant has recovered from the operative correction of the malformation, significant late complications are rare, and the great majority of individuals lead completely normal lives.