. In our department, we perform an anastomosis of the native esophagus after patient-adapted elongation therapy avoiding gastric pull-up and colonic interposition.The aim of study was to investigation of challenges and results of our approach lengthening procedure in children with long-gap esophageal atresia.Material and Methods. Five children with CLGEA (≥5 vertebral bodies gap) were referred to our department in 2016. All patients had been operated on previously at outside facilities. All children were admitted to our department with esophagostomy and gastrostomy after having anastomotic insufficiency and/or esophageal-(in two cases) or colonic interponate necrosis (in one case). As one of our major goals is to perform an anastomosis of the native esophagus, we used a Foker-technique [1,2] (Fig. 1) using traction sutures to lengthen the esophageal pouches within days and multistaged extrathoracic esophageal elongation described by Kimura [2] (Fig. 2), to solve the long gap problem and make a primary repair possible.Outcome variables included number and type of interventions, stenosis and anastomotic leak rates, number of dilatations, time to oral feeding, postanastomotic weight gain, and other complications. Currently, there is no uniform consensus in treatment of complex long-gap esophageal atresia (CLGEA). In our department, we perform an anastomosis of the native esophagus after patient-adapted elongation therapy by esophageal traction. This study describes results, challenges, and complications of our approach.