Ivor Lewis procedure

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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 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

-An Ivor Lewis (also known as a gastric-pull up) procedure is an upper gastrointestinal tract operation performed for distal oesophageal pathology, usually <a title="Oesophageal cancer" href="/articles/oesophageal-carcinoma-1">oesophageal cancer</a>.Due the necessity of removing a significant length of the <a title="oesophagus" href="/articles/oesophagus">oesophagus</a>, the <a title="Stomach" href="/articles/stomach">stomach</a> is "pulled-up" into the thoracic cavity. The resulting appearances can be striking on chest x-ray, with the appearances similar to <a title="Achalasia" href="/articles/achalasia">achalasia</a>.<h4>Differential diagnosis</h4><ul><li><a title="Mega-oesophagus" href="/articles/mega-oesophagus">mega-oesophagus</a></li></ul>
+An Ivor Lewis procedure (also known as a gastric-pull up) procedure is a type of <a title="Oesophagectomy" href="/articles/oesophagectomy">oesophagectomy</a>, an upper gastrointestinal tract operation performed for mid and distal oesophageal pathology, usually <a href="/articles/oesophageal-carcinoma-1">oesophageal cancer</a>.Due the necessity of removing a significant length of the <a href="/articles/oesophagus">oesophagus</a>, the <a href="/articles/stomach">stomach</a> is "pulled-up" into the thoracic cavity. The resulting appearances can be striking on chest x-ray, with the appearances similar to <a href="/articles/achalasia">achalasia</a>.<h4>Procedure</h4><ul>
+<li>laparotomy<ul>
+<li>stomach mobilized, the oesophagus</li>
+<li>"gastric tube" may be formed</li>
+<li>abdominal lymphadenectomy</li>
+<li>possible pyloroplasty or pylormyotomy (not practiced by all surgeons)</li>
+</ul>
+</li>
+<li>right thoracotomy<ul>
+<li>oesophagus and adjacent tissue removed en bloc
+</li>
+<li>mediastinal lymphadenectomy</li>
+<li>stomach (or gastric tube) pulled into chest and anastomosed with the more proximal oesophagus</li>
+</ul>
+</li>
+</ul>Conduit is usually paravertebral, but may be substernal or right paratracheal.<h4>Differential diagnosis</h4>The imaging differential diagnosis includes<ul>
+<li><a href="/articles/mckeown-procedure">McKeown procedure</a></li>
+<li><a href="/articles/achalasia">achalasia</a></li>
+<li><a href="/articles/mega-oesophagus">mega-oesophagus</a></li>
+</ul>

References changed:

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. <a href="http://dx.doi.org/10.1148/rg.2016150126">doi:10.1148/rg.2016150126</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/26761533">Pubmed citation</a>

Updates to Synonym Attributes

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Ivor Lewis procedure

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