Ivor Lewis procedure
Ivor Lewis procedure (also known as a gastric pull-up) is a type of oesophagectomy, an upper gastrointestinal tract operation performed for mid and distal oesophageal pathology, usually oesophageal cancer.
Due to 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 mobilised, the oesophagus
- "gastric tube" may be formed
- abdominal lymphadenectomy
- possible pyloroplasty or pyloromyotomy (not practised by all surgeons)
- right thoracotomy
- oesophagus and adjacent tissue removed en bloc
- mediastinal lymphadenectomy
- stomach (or gastric tube) pulled into the 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