Foreign bodies in the esophagus are common clinical emergencies and can be removed by esophagoscopy and Foley’s tube in most patients [1]. If an embedded foreign body cannot be removed by esophagoscopy or other methods, or if esophageal perforation is suspected, early surgical treatment is necessary [1, 2]. The surgical treatment of five cases of embedded esophageal foreign bodies admitted to our department is reported below. Embedded foreign body: 2 cases of denture, 1 case of snapper bone, 1 case of steel needle and 1 case of duck skull. The foreign body was located in the cervical esophagus in 1 case, the upper thoracic esophagus in 3 cases, and the lower thoracic esophagus in 1 case. The foreign body was obstructed for 6 to 72 h. Before surgery, three patients underwent esophagoscopy for two times, one patient for three times, and one patient for four times. Surgical methods and results One case of foreign body removal through left cervical oblique incision; three cases of foreign body removal through right posterior-lateral chest incision and one case of foreign body removal through left posterior-lateral chest incision. Three patients had the esophageal incision closed by simple sutures, and two patients had a pleural flap or intercostal muscle covered outside the esophageal incision and a flushing tube placed outside the incision for continuous metronidazole flushing. four patients healed at stage I. one case had a 1m esophageal leak and was discharged after healing. The follow-up was 1-5y without esophageal stricture. Discussion Once the diagnosis of esophageal foreign body is clear, we should try to remove it as soon as possible. The foreign body is embedded in the lumen of the esophagus and the mucosal trauma causes edema, which aggravates the obstruction, and if swallowed by force, it aggravates the local injury. (3) esophageal perforation is more serious than other parts of the gastrointestinal tract, and delayed diagnosis and treatment can often lead to perforation, which can result in serious consequences such as peri-esophageal abscess, mediastinal infection, esophagobronchial fistula and esophageal aortic fistula [3]. Diagnosis Based on the history and clinical manifestations, the diagnosis is usually not difficult. X-ray is the main method to diagnose esophageal foreign body and is also an important tool to diagnose esophageal perforation. Frontal and lateral cervical and thoracic radiographs should be performed as a routine. For patients with suspected esophageal perforation, esophagogram can be performed with iodinated oil or pantopamine. Esophagoscopy not only clarifies the site of foreign body retention and damage to the esophageal wall, but is also the main treatment tool [5]. It should be emphasized that this examination should be performed as soon as possible in the absence of absolute contraindications. Preoperative preparation In addition to the usual emergency preoperative preparation, accurate preoperative localization of the foreign body is very important. After anesthetic intubation and other operations are completed, it is advisable to perform a bedside x-ray for final localization. It is also necessary to perform another esophagoscopy at this time, because under general anesthesia, the muscle layer of the esophageal wall is relaxed and sometimes foreign bodies can be removed without surgery [6]. Surgical indications and methods In our group’s experience, we believe that early surgery should be considered for patients with sharp foreign bodies, special shapes, large sizes, which cannot be removed by more than two esophagoscopies or are estimated to cause serious esophageal injury if forcibly removed, or for patients with suspected esophageal perforation and foreign bodies closely related to the thoracic aorta. The surgical route is determined by the location of the foreign body. A left cervical oblique incision is usually used for cervical esophageal foreign body, and a right posterior lateral incision is usually used for upper thoracic esophageal foreign body. After exposing the esophagus, the foreign body can be found outside the esophagus. According to the size of the foreign body, the corresponding length of the esophagus is incised longitudinally and the foreign body is lightly removed. If there is any difficulty, the foreign body can be removed by reaching into the esophageal lumen with the little finger to investigate the relationship between the foreign body and the esophageal wall, and to remove the cause of foreign body retention. After the foreign body is removed, the damage to the esophageal mucosa and muscle layer should be carefully examined and repaired if necessary. Disinfect the area around the esophageal incision with iodophor or hydrogen peroxide. For patients with no perforation or incomplete perforation, the mucosal and muscular layers should be sutured separately. In cases with perforation but only mild infection, the pleural flap or intercostal muscle can be placed outside the esophageal incision to prevent the development of esophageal fistula. The healing of the cervical incision should be closely monitored and the incision should be opened and drained promptly if there are signs of infection. The literature reports that most of the esophageal perforations caused by foreign bodies occur within 24 hours [3], and the experience of our department in treating six cases shows that surgical treatment has an irreplaceable role for embedded foreign bodies that cannot be removed by esophagoscopy. With the advancement of anesthesia and monitoring methods and the improvement of surgeons’ surgical techniques, early surgery is more complete and effective.