Pediatric Surgery encompasses a multitude of specialty practice domains and thus requires detailed knowledge in a wide arena of topics.  It is thus unique among surgical specialties for the breadth of knowledge that is required, emphasizing the potential utility of a volume on controversial topics in this specialty.  Because of the challenges in performing clinical research in a pediatric population, the availability of high quality evidence is substantially less than that in other surgical specialties.  This highlights the utility of having recognized experts opine on carefully selected well defined clinical questions.The complexity of decision making in medicine, and in surgery in particular, is growing exponentially. As new technology is introduced, physicians from nonsurgical specialties offer alternative and competing therapies for what was once the exclusive province of the surgeon.  In addition, there is increasing knowledge regarding the efficacy of traditional surgical therapies.  How to select among these varied and complex approaches is becoming increasingly difficult.  The Difficult Decisions in Surgery series was developed to address some of these challenges.  To date, 10 volumes have been published, and they are finding enthusiastic audiences.  The volumes are multi-authored, containing brief chapters, each of which is devoted to one or two specific questions or decisions within that specialty that are difficult or controversial.  The volumes are intended as a current and timely reference source for practicing surgeons, surgeons in training, and educators, and describe the recommended ideal approach, rather than customary care, in selected clinical situations.  Recommendations are based on published evidence, and authors’ personal approaches to these problems are also shared. The chapters in each volume adhere to a specific format.  This approach provides uniformity to thepresentations, making it possible to identify useful material at a glance:  ·         a brief general introduction ·         identification of the specific characteristics relative to the question using PICO formatting ·         a brief description of the literature search process ·         a summary of available published evidence in tabular form ·         a general discussion ·         a recommendation using GRADE format ·         illustrations (other than survival curves or similar graphs) are discouraged. ·         use of uniform text formatting, volume size, volume length, and cover material enhances the brand recognition of the series. ·         the editors for each volume are selected from among the faculty at The University of Chicago, an institution with high name recognition. 
