The repair of esophageal atresia with a long gap still continues to pose difficulties for the surgeon. There is general agreement that the child's own esophagus is best, but it is also believed that a primary repair is not always possible. Foker JE et al. (1997) developed a technique of esophageal lengthening using external traction sutures. We experienced one case of esophageal atresia with a 4.5cm gap (4 vertebral spaces) which was repaired using the external traction suture technique.