Laparoscopic removal of an Angelchik prosthesis | Read …
Removal of Angelchik prosthesis
Although many reports of Angelchik prosthesis removal have ..
This case suggests that laparoscopic removal of Angelchik prosthetic rings is feasible for surgeons familiar with advanced laparoscopic procedures of the esophageal hiatus and should be considered for symptomatic patients, even if the ring was inserted via an open operation.
The Angelchik prosthesis, first described in 1979, is a c-shaped silicone device designed to treat refractory gastroesophageal reflux disease (GERD). It gained popularity due to the simplicity of device placement around the esophagus at the gastroesophageal junction (GEJ). By 1983, surgeons had placed more than 25,000 devices. Angelchik and Cohen reported a cohort of 122 patients, of whom 92% were free from reflux symptoms in early follow-up. They described the device to be a safe, simple, and “permanent” solution based on 1 year of follow-up data. However, dysphagia, strap malfunction, device migration, and erosion into the esophageal lumen contributed to an eventual removal rate of 24%, and led to abandonment of the procedure. Most complications occurred within 5 years of follow-up.
Angelchik prosthesis - [PDF Document]
The Angelchik procedure was thought to be a simple and safe modality for the treatment of GERD based on initial randomized control trial. Unfortunately, extramural device migration secondary to strap rupture was a common problem with the first generation of Angelchik devices, leading to intestinal obstruction and abdominal pain. The second generation device, introduced in 1982, featured a single tying strap and lower complication rates of rupture (4% vs. 33%) and migration (4% vs.7%). There are few studies to date investigating the long-term effects of the Angelchik prosthesis. In 2001, Subodh et al performed an extended follow-up review of patients who received Angelchik prosthesis from 1983 through 1994. Sixtyfive patients were followed for an average of 145 months. Complications included dysphagia (40%), persistent GERD (15%), and prosthesis migration (10%). Fifteen percent of patients required removal of the prosthesis due to adverse symptoms.
This case suggests that laparoscopic removal of Angelchik prosthetic rings is feasible for surgeons familiar with advanced laparoscopic procedures of the esophageal hiatus and should be considered for symptomatic patients, even if the ring was inserted via an open operation.">
THE ANGELCHIK PROSTHESIS: RESULTS AND …
Since then, case reports have highlighted late complications as many as 15-25 years after prosthesis placement. Plaiser et al reported a case of Angelchik migration prompting laparoscopic removal 17 years after placement. Transmural migration (erosion) is a rare complication recently reported to occur in 1.5% of cases. Carbonell et al reported a case of prosthesis erosion into the GEJ, necessitating transgastric removal 25 years after placement, an approach chosen to avoid entry of the fibrous capsule surrounding the device. Authors have described endoscopic removal of eroded prostheses, which allows patients to avoid potentially morbid surgical procedures. Recurrent GERD symptoms can occur as late as 15 years after prosthesis placement. In reported cases, inadequate GERD control after prosthesis placement led to subsequent Nissen fundoplication, and in 3 patients, esophageal adenocarcinoma.
Complications of the Angelchik antireflux prosthesis: endoscopic ..
Angelchik antireflux prosthesis: ..
07/02/2017 · Complications of the Angelchik prosthesis in the management of gastroesophageal reflux
Angelchik prosthesis revisited. - Medscape
21/01/2008 · Fifty-four patients who had the angelchik antireflux prosthesis inserted ..
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