The authors herein report their personal experience in the management of 21 patients with iatrogenic perforation of the esophagus, collected in a fifteen-year period. The etiology was more commonly a hiatal surgical procedure (28.6%), following diagnostic endoscopy (19%), endoscopic dilatation for achalasia (19%) and foreign body (19%). Consequently, 47.6% of the lesions were located in the abdominal, 28.6% in the thoracic and 23.8% in the cervical esophagus. Treatment was set up at surgery in 28.6%, within 6 hours in 47.6% and within 48 hours in 9.6%. Conservative medical management was successfully carried out in three cases (14.2%). As a result of their policy of "tailored" treatment on single lesion characteristics (size and location, underlying esophageal diseases, early or delayed diagnosis) they report an overall mortality rate of 28.6%, the prognosis being worse in thoracic (50%) than in abdominal perforations (30%). Based on this series and on a literature review the authors suggest that the best management should be "tailored" to single patients characteristics. Early diagnosis and treatment are the most important prognostic factors.