Between 1962 and 1971, a total of 12 children and adolescents underwent 29 surgical procedures without operative mortality, but with significant postoperative morbidity. Biliary tract disease was the most frequent indication for surgery. Infections and pulmonary problems were common and often difficult to control. Severe complications were prevented by preoperative transfusion, adequate hydration, and the avoidance of hypoxia, acidosis, hyperosmolality, and capillary erythrostasis. A sickle cell preparation or hemoglobin electrophoresis is advised for every black child and adolescent prior to contemplated, elective surgery.