Results of combined treatment of 850 patients with penetrating mechanical injuries of the esophagus are presented. 368 patients had instrumental lesions, 328--foreign bodies, 53--spontaneous and hydraulic ruptures, 83--gun-shot and cut wounds. Complex of roentgenologic, endoscopic, ultrasound and immunologic methods of examination were used for diagnosis of penetrating injuries of the esophagus and their complications. The authors have developed indications for conservative and operative methods of treatment. 650 patients underwent surgery. In 388 patients drainage procedures were used, other procedures used were suturing of defect of esophageal wall (288p), exclusion of distal part of the esophagus (30p). Mortality rate in such operations made up, respectively, 33, 11.8 and 6.6%. Methods of active drainage were successfully used in treatment of complication in ruptures of the esophagus (mediastinitis, empyema of the pleura). The most severe complications of the ruptures of the esophagus and mediastinitis were arrosion bleedings and esophageal fistulas. Methods of treatment of these complications are described.