Summary Twelve patients with esophageal atresia have been managed by planned delay (4–13 wk) followed by direct esophageal anastomosis. During the period of delay, the infants were maintained on continuous proximal esophageal suction and gastrostomy feeding. The proximal esophageal pouch was elongated by daily bougienage in all infants and in one instance the distal pouch was also elongated with a bougie. Five infants had atresia without fistula (Type A), four with proximal fistula only (Type B), and three with an isolated distal fistula (Type C). All of these patients, including those with Type C atresia, had a wide gap between the esophageal segments. After the definitive surgery, eight patients developed anastomotic leaks sufficient to cause symptoms. These leaks were tolerated by all infants and eventually closed spontaneously. Nine patients developed anastomotic stenosis requiring dilatations. The anastomotic stricture was later resected in two of these patients, in each, 3 yr after the primary esophageal anastomosis. Presently, all 12 patients are living at home, able to eat and have normal activities. Five patients have no symptoms, four complain of occasional mild dysphagia with solid food when they eat too fast or take large bites of food and in three patients periodic esophageal dilatations are necessary to relieve dysphagia for solids. In a patient with esophageal atresia and a large gap between the esophageal segments, esophageal pouch lengthening during a period of planned delay makes anatomic reconstruction of the esophagus possible and esophageal replacement unnecessary. Our experience with this technique has been gratigying. The prerequisite for this elongation regimen is presence of the lower esophageal pouch, albeit short and small.