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As a pediatric surgeon for over thirty-five years, Koop operated on a large number of children with congenital birth defects, correcting many such defects but knowing also that some of his patients would be left with impairments. Koop stayed in contact with many of the families of children on whom he had operated. He made the long-term medical care, educational opportunities, job prospects, and social integration of children with disabilities one of his main concerns as U.S. Surgeon General.