General Surgery · Upper GI
Ivor Lewis Oesophagectomy
Ivor Lewis Oesophagectomy
DATE AND TIME: [Date and time] URGENCY: Elective / Non-elective SURGEON: [Name] ASSISTANT: [Name / None] ANAESTHETIST: [Name] OPERATION: Ivor Lewis Oesophagectomy (Laparotomy and Right Thoracotomy with Intrathoracic Anastomosis) ANAESTHETIC: General anaesthesia — double-lumen endotracheal tube. Thoracic epidural placed pre-operatively. ANTIBIOTICS: IV antibiotics at induction. VTE prophylaxis from induction. DVT PROPHYLAXIS: [Agent / mechanical / Not indicated] POSITION: Supine (abdominal phase), then left lateral decubitus (thoracic phase). INDICATION: Carcinoma of the distal or mid oesophagus / gastro-oesophageal junction — suitable for intrathoracic anastomosis. Advantages: direct dissection of tumour in chest, good nodal clearance, less recurrent nerve risk than cervical anastomosis. [Preoperative: EUS, CT staging, PET-CT, OGD by surgeon]. [Neoadjuvant chemoradiotherapy completed]. Nutritional assessment — J-tube planned. PHASE 1 — LAPAROTOMY AND GASTRIC MOBILISATION: Upper midline laparotomy. Abdominal exploration — metastatic disease excluded. Right gastroepiploic artery palpated — pulse confirmed strong.