Ivor Lewis procedure

Dr Henry Knipe and Dr Ian Bickle et al.

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.

Procedure

  • laparotomy
    • 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.

Differential diagnosis

The imaging differential diagnosis includes:

Oesophageal pathology
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Article information

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

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4: appearances on swallow study
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