Upper GI

Oesophagectomy (Ivor Lewis)

OESOPHAGECTOMY (IVOR LEWIS)

Indication: Carcinoma of the middle or distal oesophagus or gastro-oesophageal junction. Suitable for resectable lesions without distant metastasis. Allows direct thoracoscopic or thoracotomy access for clean resection with intrathoracic anastomosis.

Patient Position: Supine (abdominal phase) then left lateral decubitus (thoracic phase).

Anaesthesia: General with double-lumen tube (one-lung ventilation for thoracic phase).

Prophylactic Antibiotics: Per protocol.

Phase 1 — Abdominal:
1. Upper midline laparotomy (or laparoscopic approach).
2. Stomach mobilised on right gastric and right gastroepiploic arterial pedicle. Left gastric, short gastric, and left gastroepiploic vessels divided. Omentum preserved on gastric conduit.
3. Gastric conduit fashioned by dividing along lesser curvature with linear stapler, creating a 4–5 cm wide tubular stomach.
4. Pyloromyotomy or pyloroplasty performed (vagal denervation during oesophageal resection causes delayed gastric emptying).