Year: 2011
Type: dissertation
Abstract: Much has been written on perforated peptic ulcer (PPU) during the last hundred years. \\nIn 1500, when necropsies were first allowed, often a small hole was found in the \\nanterior wall of the stomach, giving an explanation for symptoms of acute abdominal \\npain, nausea, vomiting which often led to death within a few hours or days. \\nLaparoscopic surgery, also called minimal invasive surgery or keyhole surgery is a \\nsurgical technique in which operations are performed through small incisions as \\ncompared to the larger incision needed in traditional surgical procedures. Georg \\nKelling performed the !rst laparoscopic procedure in dogs in 1902 and in 1910 Hans \\nChristian Jacobaeus was responsible for the first laparoscopic procedure in humans, \\nbut it took till the 80s of the last century before laparoscopic procedures became \\npopular. Benefits of laparoscopic surgery are less postoperative pain, minimal scarring \\nand lower morbidity and mortality. A review of the history of perforated peptic ulcer \\ndisease (PUD) has been written in chapter 1 and a review on laparoscopic correction \\nfor PPU has been written in Chapter 2. The aim of this thesis was to demonstrate if \\nlaparoscopic correction of PPU was feasible and if it was superior to the routine \\ncorrection of PPU by upper laparotomy. For this a Dutch multicenter trial, the LAMA \\ntrial, was performed. During this trial several questions raised, which led to more \\nresearch. First of all, reviewing literature on this topic, it became clear that consensus \\non several topics was lacking (Chapter 3, 4). A European questionnaire was sent to get \\nan impression of the current preferred methods of choice (Chapter 5). During the \\nLAMA trial it was discovered that the laparoscopic suture procedure sometimes led to \\nproblems. Therefore an alternative technique for closure of the perforation without \\nthe need for suturing was tested in rats (Chapter 6 and 7). Finally, during surgery for \\nPPU routinely a biopsy is taken for testing on Helicobacter pylori (H.pylori), one of the \\nmain causes for the occurrence of peptic ulcer disease. It was questioned if testing \\nthe abdominal fluid or serum could replace the need for a biopsy, but also it was \\nevaluated if there was one genetic type of the H.pylori responsible for the emergence \\nof PPU, which could be an important factor in the prevention of PPU (Chapter 8).
Author: M. J. O. E. Bertleff
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1903630392