Surgery in the South Pacific is different in many respects from surgery in Australia and New Zealand. It is primarily the surgery of trauma, infection, advanced malignancy, hollow-tube obstruction and congenital abnormalities. Specific tropical infections such as tuberculosis, typhoid, pigbel and amoebiasis occur regularly but constitute only a small proportion of all cases. The patients tend to be young, rural and poor, and often present late because access to surgical services is limited. The treatment patients receive is also compromised by a lack of resources--the result of underfunding and inefficient administration. Standards for appropriate surgical practice should be determined in-country and based at least on surgical audit and clinical studies. Even though Western diseases are emerging in the tropics, the best management may sometimes be different. Training of national surgeons is a priority if a sustainable surgical service is to be established. Such training is more effectively carried out in the home country, or at least in one with similar pathology and problems, rather than overseas. Project aid should support these schemes and encourage regional co-operation through the Fiji and Papua New Guinea medical schools. There remains an important role for visiting surgical specialists, but they need to ensure that they transfer skills and encourage the professional development of promising local doctors rather than simply focusing on treating patients.