Minimally Invasive Esophago- Gastrectomy with Intra Thoracic Anastomosis (ivor-Lewis)

C Palanivelu, MCH FACS FRCS, S Rajapandian, MS DNB, R Sathiyamurthy, MS, P Praveenraj, MS, R Parthasarathi, MS, V Vaithiswaran, MS. GEM Hospital

Introduction:Commonest type of Gastro esophageal junction growth in our region is Siewert type III with involvement of the cardia. After resection with adequate margin, the length of the stomach tube might not reach the neck. In such situations Ivor-Lewis Esophago- Gastrectomy with intra thoracic anastamosis is a good alternative. Procedure:- Laparoscopically the stomach is mobilized preserving the right gastro-epiploic vessels. -Lymph nodes along all named vessels are removed. -Greater curvature tube is formed ensuring a distal margin of 5 cm. The esophagus is transected 10 cm proximal to the GE junction. -The stomach tube is sutured by loose stitch to the hiatus. -The specimen is extracted through a Pfannenstiel incision. -Patient is then placed in prone position and through a right thoracoscopic approach, the cut end of the esophagus is further moblised till the azygos vein. -Further 5 cm of the esophagus is cut and removed in a endobag through the 12 mm port site. -A side to side esophago gastric anastamosis is performed using endo GIA staplers.


Session: SS15
Program Number: V034

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