Reconstruction and repair of atresia or defect of the upper portion of esophagus is difficult. From November 1980 to December 1997, forth-five cases, consisting 35 males and 10 females, were treated with microsurgical technique. The 45 patients fell into the following groups as esophageal atresia of various causes in 21 cases, anastomotic fistula or stenosis following reconstruction of esophagus in 7 cases and late carcinoma of esophagus in 17 cases. The types of reconstruction consisted of transfer of free jejunum with its lower portion carrying a vascular pedicle in 24 cases, free transfer of jejunal graft in 15 cases, free vascularized jejunal graft in 2 cases and free vascularized tubular skin graft in 4 cases. After a follow-up of 6-19 months besides eight cases died from late esophageal carcinoma, thirty-seven cases were survived and could take food by mouth. All of the benign cases could return to work. In patients having late esophageal carcinoma, the operative procedure could improve the life quality and facilitate chemotherapy and radiotherapy.