Objective: Aim of this study is to assess the paediatric surgical caseload, spectrum of paediatric surgical conditions managed, various paediatric surgical operative procedures performed and outcome of the same in existing set-up. Methods: It is retrospective analysis of the paediatric surgical services provided by a single unit in a tertiary care hospital affiliated to State Government run Medical College in Maharashtra, India. The study period extends from January 2016 to December 2018. Data acquisition was done by compiling and cross -checking the computerized and non-computerized hospital records. Total 2577 children from day one old neonate up to 15 years of age with surgical disorders were included in this study. There were 1518 male children and 1059 female children. Among these, 986 were neonates. Results: Percentage bed occupancy averaged 90%. The most common diagnoses on admission were congenital anomalies (90.25%), surgical infections (6.2%) followed by trauma (3.4%). Forty-six different operative procedures were performed. Paediatric surgical procedures accounted for 2.5% of all operations carried out in the hospital during the study period. Overall mortality was 9.1%. Peri-operative mortality was 2.9%. Conclusions: This study aims to emphasize the spectrum of work done by paediatric surgery unit in the set up of tertiary care hospital affiliated to State Government run Medical College. It also highlights the need of strengthening the paediatric surgical services by establishing full-fledged paediatric surgery department with separate surgical ward and well-equipped surgical intensive care unit. This will ensure prompt and improved patient care and help bring down morbidity and mortality of children requiring surgical intervention.