Vreeland TJ, et al. - Given the grave consequences of a bile leak in the setting of an en bloc diaphragm resection and mesh reconstruction, authors presented the technique for resection, reconstruction, and “air leak test” (ALT) in the case of a 29-year-old woman who had metastatic teratoma with an 8 × 7-cm liver metastasis in segment 7 and diaphragm invasion to the level of the right hepatic vein. In this case, a formal right posterior sectionectomy with en bloc diaphragm resection was performed. Using biologic mesh (Surgimend, Integra LifeSciences, Plainsboro, NJ) reconstruction of the 12 × 8-cm diaphragmatic defect was done. They identified several areas of bubbles from biliary radicles on the cut surface of the liver performing an intraoperative ALT (air injection into the cystic duct with finger compression of the distal bile duct), these areas were ligated with 4-0 polypropylene. Repetition of ALT was done until no bubbles remained. There was no requirement for the surgical drain as there was no evidence of bubbles. With no complications, the patient did well postoperatively. Prevention of bile leak, with subsequent contamination of the diaphragm repair and even the thoracic cavity, is particularly important in cases of combined liver and diaphragmatic resection. Mitigation of the risk of bile leak and organ-space infection, as well as associated sequelae on quality of life, return to intended oncologic therapy, and oncologic outcomes can be achieved with an easily replicated intraoperative air leak test.