Unusual problems in the surgery of the oesophagus in childhood can be devided into two groups : 1. Unusual problems in conditions seen infrequently. 2. Unusual problems in frequently encountered conditions. The following conditions will be considered as examples of Group 1-unusual problems in conditions seen infrequently. (I) Neonatal rupture of the oesophagus. (ii) Explosive rupture of the oesophagus. (iii) Achalasia. (iv) A miscellany of unsual conditions including naso-gastric intubation stricture of the mid-oesophagus of unknown aetiology and pharyngo-oesophageal occlusion. Group 2-unusual problems in frequently encountered conditions. In this group discussion will relate to the following conditions : - (I) Oesophageal Atresia-unusual problems. (ii) Gastric involtment following corrosive ingestion. (iii) Unusual manifestations of peptic oesophagitis. Consideration of the above conditions indicates that unusual problems do occur in the surgery of the oesophagus in childhood and the problems involve a wide spectrum of congenital and acquired diseases. Awareness of such problems should alert the clinician to diagnosis and thus therapeutic decisions will be facilitated. In addition, it may be possible to provide an early assessment of the prognosis. It is suggested that consideration could well be given to establishing an International Register of oesophageal diseases in childhood.
The principles of the developments in optics and lighting which have so greatly improved endoscopy in recent years will be concisely but briefly reviewed. This involves an ingenious change in telescopic systems and the incorporation of fiber threads, for lighting in the rigid instruments; and the use of fiber optics for both lighting and viewing in the flexible instruments. The advantages to bronchoscopy and esophagoscopy, particularly in small infants will be reviewed and then will be demonstrated by motion picture representation of such examinations and treatments. Laparoscopy will be discussed in greater detail and will also be demonstrated by motion pictures. Urethrocystoscopy, vaginoscopy and procto-sigmoidoscopy will only be very briefly discussed. Attention will then be turned to studies with the flexible endoscopes : gastroduodenoscopy, colonoscopy, and a miscellaneous group of cases. Our results and a review of our cases will be described.