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Pediatric surgery has emerged from general surgery to take better care of the needs of surgically ill children. The development of pediatric surgery in Germany started in the early 19th century and is still ongoing. This study was performed to investigate how pediatric surgery is organized in Germany.Data were obtained from the following sources: German Society, Information System of the Federal Health Monitoring, German Medical Association, Joined Federal Committee, Federal Bureau of Statistics, and Perinatal Centers.Pediatric surgery in Germany was started in the beginning of the 19th century. In 1962, there were approximately 20 units. The number increased to 98 in 2005 and to 129 in 2017. Presently, there are 769 pediatric surgeons registered in Germany. The current growth of pediatric surgery is attributed to a political decision of implementing centers for the care of preterm babies who need pediatric surgeons. Most work performed by pediatric surgeons in Germany can be categorized as low-risk, high-volume surgery. Currently, there is a trend of spontaneous centralization for some high-risk, low-volume pediatric surgical procedures.Pediatric surgery in Germany shows a development toward a nearly complete coverage of the country, thus providing increasing number of children with specialist care. Rare diseases, such as in oncology or newborn surgery, are generally not centralized and rarely performed by small units. New approaches for better quality measurements may lead to centralization even without political action in the future.