Ivor Lewis procedure
An Ivor Lewis procedure (also known as a gastric-pull up) procedure is a type of oesophagectomy, an upper gastrointestinal tract operation performed for mid and distal oesophageal pathology, usually oesophageal cancer.
Due the necessity of removing a significant length of the oesophagus, the stomach is "pulled-up" into the thoracic cavity. The resulting appearances can be striking on chest x-ray, with the appearances similar to achalasia.
- stomach mobilized, the oesophagus
- "gastric tube" may be formed
- abdominal lymphadenectomy
- possible pyloroplasty or pylormyotomy (not practiced by all surgeons)
- right thoracotomy
- oesophagus and adjacent tissue removed en bloc
- mediastinal lymphadenectomy
- stomach (or gastric tube) pulled into chest and anastomosed with the more proximal oesophagus
Conduit is usually paravertebral, but may be substernal or right paratracheal.
The imaging differential diagnosis includes
- oesophageal dysmotility
- oesophageal tumours
- benign oesophageal neoplasms
- malignant oesophageal neoplasms
- gastro-oesophageal reflux disease
- oesophageal stricture