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Related Concept Videos

Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
154
Esophageal Strictures-II: Clinical Features and Management01:26

Esophageal Strictures-II: Clinical Features and Management

169
Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
169
Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

364
Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
364
Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

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Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
154
Esophageal Strictures-I: Introduction01:30

Esophageal Strictures-I: Introduction

284
Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
284
Barrett Esophagus-II: Clinical Manifestations and Management01:21

Barrett Esophagus-II: Clinical Manifestations and Management

321
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
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Related Experiment Video

Updated: Sep 19, 2025

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
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Decreasing Complications After Ivor-Lewis Esophagectomy: Is a Totally Minimally Invasive Approach the Solution?

Parit T Mavani1, Caitlin Sok1, Pranay S Ajay1

  • 1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.

Journal of Surgical Oncology
|June 18, 2025
PubMed
Summary

Totally minimally invasive Ivor Lewis Esophagectomy (ILE) significantly reduces major postoperative complications and length of stay compared to open and hybrid approaches. This finding supports the TMIE approach for improved patient outcomes in esophageal cancer surgery.

Keywords:
Ivor‐Lewis esophagectomyminimally invasive approachoperative approachpostoperative complication

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Area of Science:

  • Surgical Oncology
  • Thoracic Surgery
  • Gastrointestinal Surgery

Background:

  • Ivor Lewis Esophagectomy (ILE) is a critical curative treatment for invasive esophageal cancer.
  • Despite advancements, ILE is associated with significant morbidity and mortality.
  • Comparing different surgical approaches is essential for optimizing patient outcomes.

Purpose of the Study:

  • To compare postoperative outcomes of open (OE), hybrid (HE), and totally minimally invasive (TMIE) Ivor Lewis Esophagectomy.
  • To identify factors associated with major postoperative complications after ILE.
  • To evaluate the efficacy of TMIE in reducing complications and length of stay.

Main Methods:

  • Retrospective review of 135 patients undergoing elective ILE (2018-2022).
  • Exclusion of transhiatal, McKeown, and emergent esophagectomies.
  • Multivariable analysis (MVA) to assess factors linked to major complications (Clavien-Dindo Grade ≥3).

Main Results:

  • TMIE (n=45) showed a shorter median length of stay (9 days) versus OE (n=40, 12 days) and HE (n=50, 13 days) (p<0.001).
  • TMIE had a lower major postoperative complication rate (13.3%) compared to OE (32.5%) and HE (36%) (p=0.03).
  • MVA confirmed TMIE's protective effect: OE (aOR 3.4, p=0.04) and HE (aOR 5.5, p=0.002) had higher complication risks versus TMIE.

Conclusions:

  • Totally minimally invasive Ivor Lewis Esophagectomy is linked to fewer major postoperative complications and shorter hospital stays.
  • The TMIE approach demonstrates superior outcomes in the studied patient cohort.
  • Further prospective studies in the US are recommended to standardize TMIE for esophageal cancer treatment.