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 the appearances similar to achalasia.
- stomach and esophagus mobilized
- "gastric tube" may be formed
- abdominal lymphadenectomy
- possible pyloroplasty or 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.
The imaging differential diagnosis includes:
- 1. Flanagan JC, Batz R, Saboo SS et-al. Esophagectomy and Gastric Pull-through Procedures: Surgical Techniques, Imaging Features, and Potential Complications. Radiographics. 2016;36 (1): 107-21. doi:10.1148/rg.2016150126 - Pubmed citation
- 2. Zhai C, Liu Y, Li W, et al. A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis. 2015;7(12):2352-8. doi 10.3978/j.issn.2072-1439.2015.12.15
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- malignant esophageal neoplasms
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- esophageal stricture