Current approaches to the repair of long-gap esophageal atresia (EA) favor esophageal anastomosis. This investigation provides a midterm follow-up of long-gap EA with a primary repair to determine whether this procedure affects symptom severity and whether symptom severity may predict worsening of dysmotility. Fifteen children at least 1-year post primary repair were divided into group 1 (long-gap) and group 2 (non-long-gap). The severity of their symptoms was graded using a questionnaire focused on their eating habits and gastroesophageal motor dysfunction symptoms. Esophageal transit time and gastric emptying were assessed by scintigraphy and used to grade esophagogastric dysmotility. At midterm follow-up the majority of patients in both groups were asymptomatic (66% in group 1 vs 77.7% in group 2; P > 0.05). Esophagogastric dysmotility grades for group 1 were more severe than for group 2 (median 2.5, range from 1 to 4 vs median 1, range from 1 to 2, respectively; P > 0.05). We found no relationship between the severity of the symptoms and the presence or severity of esophagogastric dysmotility. At midterm follow-up in patients with long-gap atresia that underwent primary repair, this study showed scintigraphic evidence of silent and serious esophagogastric dysmotility in symptom-free or minimally symptomatic children. It may therefore be unreliable to use symptoms in assessing the severity of esophagogastric dysmotility, since both groups showed similar clinical findings but different scintigraphic findings.