Ivor Lewis procedure

Last revised by Tariq Walizai on 27 May 2024

Ivor Lewis procedure (also known as a gastric pull-up) is a type of esophagectomy, an upper gastrointestinal tract operation performed for mid and distal esophageal pathology, usually esophageal cancer.

Due to the necessity of removing a significant length of the esophagus, the stomach is "pulled up" into the thoracic cavity. The resulting appearances can be striking on chest x-ray, with an appearance mimicking achalasia.

  • laparotomy

    • stomach and esophagus mobilized

    • "gastric tube" may be formed

    • abdominal lymphadenectomy

    • possible pyloroplasty/pyloromyotomy (not practised by all surgeons)

  • right thoracotomy

    • esophagus and adjacent tissue removed en bloc

    • mediastinal lymphadenectomy

    • stomach (or gastric tube) pulled into the chest and anastomosed with the more proximal esophagus

The conduit is usually paravertebral but may be substernal or right paratracheal.

Potential advantages over the McKeown procedure are lower rates of stricture, leak, recurrent laryngeal nerve palsy, and aspiration 2.

Minimally invasive Ivor Lewis esophagectomy (MI-ILE) is an alternative for open method which discusses its clinical outcomes, and introduces the robotic approach in MI-ILE. MI-ILE has demonstrated postoperative outcomes and it has shown potential to reduce blood loss and length of hospitalization as compared to open surgery.

  • tubular paramediastinal structure

    • extending from cardiophrenic angle to thoracic inlet

    • may have air-fluid level

  • evidence of right-sided thoracotomy 

    • rib deformity

    • suture material or mediastinal surgical clips

  • absent stomach bubble

The distinguished Welsh surgeon Ivor Lewis (1895-1982) first described his procedure in the Hunterian Oration at the Royal College of Surgeons in 1946 3,5.

The imaging differential diagnosis includes:

ADVERTISEMENT: Supporters see fewer/no ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.