If there is radiographic confirmation that the wall of the oesophagus has been breached, immediate operation under antibiotic cover is indicated. For perforations of the cervical oesophagus, an approach via the anterior border of sternomastoid with retraction of the carotid sheath is taken. Lower perforations require a full thoracotomy.
The oesophagus is closed in two layers with non-absorbable sutures. A drain may be left in situ.
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