This chapter explores oesophageal exclusion as a method of diverting contaminants like saliva, fluids, and gastric contents, particularly in cases of large perforations or fistulas. The goal is to control mediastinal and chest sepsis while awaiting definitive treatment. Various exclusion techniques are discussed, including loop oesophagostomy, lateral oesophagostomy, and end oesophagostomy, each with its benefits and considerations for future reconstruction. Additionally, the chapter covers the use of intercostal muscle flaps for bolstering repairs, gastric exclusion to prevent reflux, and techniques for feeding jejunostomy. It also delves into the management of thoracic collections and sepsis, highlighting the importance of choosing the right intervention at the right time. Endoscopic vacuum therapy, including the EsoSponge and VAC-Stent, are presented as effective options for managing oesophagogastric perforations and leaks, with emphasis on proper placement and regular monitoring for optimal outcomes. Overall, the chapter provides a comprehensive overview of bridging strategies and reconstruction techniques essential for managing complex oesophageal conditions.