At the Royal Children's Hospital, Melbourne, 375 patients with oesophageal atresia and/or tracheo-oesophageal fistula have been admitted under the care of one surgical unit and, as with other reported series, there has been a predominance of the type with proximal atresia and distal tracheo-oesophageal fistula. With the object of evaluating the long-term follow-up, a review of the patients seen before 1963 has been made. During the period 1948 - 1962, 132 babies with oesophageal atresia and distal tracheo-oesophageal fistula were treated surgically with 72 survivals. A complete follow-up has been possible in 58 of these patients for periods varying from 13 to 26 years. This follow-up has shown that although oesophageal function is not normal, dysphagia is an early problem, the children are subject to recurrent respiratory infections in the early years of life, there are demonstrable radiological changes and there are demonstrable manometric abnormalities, the end result is, by and large, very satisfactory.