Ivor Lewis procedure

Dr Ian Bickle et al.

An Ivor Lewis procedure (also known as a gastric-pull upprocedure 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.

Procedure

  • laparotomy
    • 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.

Differential diagnosis

The imaging differential diagnosis includes


Oesophageal pathology
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Article Information

rID: 43088
Section: Gamuts
Synonyms or Alternate Spellings:
  • Gastric pull-up
  • Gastric pull up
  • Ivor Lewis oesophagectomy

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    Case 4: appearances on swallow study
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