Ivor Lewis Esophagectomy

Overview

The esophagus is a hollow tube that moves food and liquids from the throat to the stomach. It is located just behind the trachea (windpipe) and, in an adult, is about 10 inches long. The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle and connective tissue. 

Esophagectomy is the surgical removal of part of the esophagus. The lower part of the esophagus and upper part of the stomach (fundus) are removed and the remaining parts are then connected to re-establish the digestive tract.

Reason for an Esophagectomy

Esophagectomy is the treatment of choice for esophageal cancers.

The Ivor Lewis Esophagectomy

The Ivor Lewis is a specific, two-stage surgical approach esophagectomy. The first stage is through an incision in the abdomen to “free up” and remove part of the stomach.   This section of stomach will be formed into a replacement esophagus. The second stage is done through an incision in the chest to remove the diseased part of the esophagus, insert the newly formed esophagus, and re-attach the esophagus to the remainder of the stomach. The procedure takes about 5 hours.

The Ivor Lewis procedure is used for those who have tumors in the middle or lower third of the esophagus.

The Day of Your Surgery

• Check with your doctor before taking insulin, diabetes pills, blood pressure medicine, heart pills, or any other medication on the day of surgery.
  • Report to Admissions on the day/time you are assigned. 
• You will then go to a pre-op unit and change into a hospital gown.
• A nurse will review your chart, take your vital signs, and confirm that all the paperwork is in order. 
• An IV will be started and if you have not already done so, you will have a short consultation with an anesthesiologist. 
• You will need to remove all jewelry, dentures, contact lenses, etc. and you will be given a sedative to help you relax.
• You will then be taken to the operating room. After the anesthesia is given and you are unconscious, the surgery will be performed.

After Your Surgery

• Once the surgery is completed, you will be taken to the recovery room and then moved to the Intensive Care Unit (ICU) where you will be closely monitored. 
• You are likely to wake up with a nasogastric (NG) tube. This is a tube that enters through your nose and reaches into your stomach to drain accumulating digestive juices. After tests confirm that the area of reattachment is patent (there are no leaks), the NG tube can be removed (Usually after 5 days after the surgery) and you can begin taking fluids by mouth.   
• Until your digestive system begins functioning again, you will be given nutrition through a tube directly into your intestine, or through your veins. When nutrition is delivered directly into your veins, it is called total parenteral nutrition (TPN).
• Your bandages be monitored and changed as needed. It is important to keep them clean and dry.
• You may be given medications to prevent blood clots (blood thinners) and antibiotics to prevent infection. 
• You may be given special elastic leg stocking to help your circulation and prevent blood clots.
• You will be instructed on special breathing exercises to promote healing and prevent any respiratory complications.
• When your condition is stable, you will be moved out of the ICU to a regular hospital room.
• As soon as you are able, your nurses will help you get out of bed and begin walking. (This also promotes healing and prevents complications such as blood clots, constipation, and respiratory infections.)  
• Pain. You may have a catheter inserted during surgery that will deliver pain medication directly into our body for the first few days after surgery or you may be given a PCA (patient –controlled analgesia) pump that allows you to control the release of pain medication into your IV. Eventually, you will be moved to either injections or oral medications that will be given on a prescribed schedule. Pain medications work best when taken BEFORE the pain becomes severe. It is very important that you tell your nurses and doctors about any pain you are experiencing and to take the medications prescribed to hasten your recovery.

At Home

• Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up, even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
• When you are allowed to bathe or shower, carefully wash the stitches or staples with soap and water. Then put on a clean, new bandage. Change your bandage any time it gets wet or dirty.
• To prevent constipation, eat foods rich in fiber, such as fruit, bran, cereal, and beans. Drink plenty of liquids (prune juice may help soften the stool) and walking helps stimulate the bowel. If your doctor approves, you can take an over-the-counter fiber laxative.
• You'll need extra rest while you recuperate. Try to gradually increase your activity each day, resting whenever you feel it's needed.
• Do not smoke.

Resuming Normal Activities

• Recovery time varies.
• You will be encouraged to return to normal activities, such as showering, driving, walking up stairs, light lifting and work, as soon as you feel comfortable.
• After a month, you may resume your normal diet but eat in smaller quantities. The reduced size of the stomach limits the capacity to hold food. Instead of eating three large meals a day, eat several smaller meals.
• No heavy lifting or straining for six to eight weeks.
• If taking narcotic medications for pain, you should not drive.

Risks

As with any surgery, there are post-op risks for complications such as: infection

• Bleeding
• Adverse reaction to anesthesia
• Respiratory infections, such as pneumonia
• Esophagectomy also carries the following risks:
• Leakage (at the sites where the digestive system was re-attached)
• Breathing problems

When To Call Your Doctor

Be sure to let your doctor and nurses know if you notice any of the following symptoms:

• Fever or chills
• Persistent pain
• Drainage from any incision