Date of Award

2023

Degree Name

Doctor of Medicine

Schools and Centres

Medicine

First Supervisor

Professor Hans Van der Wall

Abstract

Upper gastrointestinal surgery has progressively moved from the surgically open abdomen to minimally invasive surgery, largely due to technological improvements in instrumentation. A direct result of this Gestalt has been improved patient comfort, rapid recovery and significantly less length of stay in the hospital and therefore significant cost-savings. This was the key impetus to my development of many of the skills in minimally invasive surgery and the subsequent dissemination to other surgeons in an organized and well-recognized teaching system. Many of the novel techniques of this type of surgery led to several publications both in the English and French oncological and gastrointestinal literature. In philosophical terms, it also led to a significant interest in gastrointestinal physiology and the setting up of a reference laboratory that led to many research publications on gastroesophageal reflux in terms of 24-hour pH/impedance and manometry. These skills also allowed the joint development and validation of a scintigraphic test for gastroesophageal reflux and its extra-oesophageal manifestations in the head, neck, and lungs. It allowed significant advances in the recognition of extra-oesophageal manifestations of reflux with the production of five PhD candidates, one of which has already been completed and two are approaching submission through the University of Notre Dame.

The implementation of minimally invasive surgery and its basis in physiological testing has spawned numerous publications that have significantly advanced upper gastrointestinal surgical outcomes which have been documented in the surgical and medical literature.

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