We examined the esophageal structure in children who underwent traction to achieve primary repair of long-gap esophageal atresia. High-resolution ultrasound was used to compare thickness of the proximal and distal esophagus in children who had traction to achieve primary repair (n=15) to cases of esophageal atresia with shorter gaps that did not require traction (n=8). The muscularis propria of the upper esophagus was thicker in the traction compared to the non-traction group, though not statistically significant (respectively, 0.79 (0.18) mm vs. 0.71 (0.16) mm; p=0.29), measurements were similar for the lower esophagus (respectively, 0.79 (0.21) mm vs. 0.75 (0.13) mm; p=0.64). Combined mucosa and submucosa was very similar in both groups for the upper (respectively, 1.03 (0.15) mm vs. 1.04 (0.16) mm; p=0.95) and lower esophagus (respectively, 1.09 (0.23) mm vs. 1.01 (0.13) mm; p=0.37). The thickness of individual mural layers is maintained after increasing esophageal length with traction.