Reoperation for complications of the Angelchik antireflux prosthesis.
The Angelchik antireflux prosthesis is associated with complications that require reoperation in 5% to 15% of patients. To determine the morbidity and success of reoperation for these complications, we conducted a retrospective study of 15 patients. Time to reoperation ranged from 3 weeks to 113 months with a mean of 31 months. Indications for reoperation included dysphagia (8 patients), recurrent reflux (6 patients), and prosthesis migration (1 patient). Ten patients underwent prosthesis removal and fundoplication, 4 had prosthesis removal without fundoplication, and 1 patient had the prosthesis repositioned. Iatrogenic splenic injury occurred in 2 patients (13%); one splenectomy and one splenic repair were done. Four patients (27%) required intraoperative blood transfusion. There were no operative deaths. Removal of the prosthesis without fundoplication resulted in a significantly higher incidence of recurrent reflux (75%) than prosthesis removal and fundoplication (10%) (p < 0.04). Although reoperation for complications of the Angelchik antireflux prosthesis can be technically difficult, morbidity and mortality are acceptable. An antireflux procedure should be done at the time of prosthesis removal.
Department of Surgery, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
K C
KC
Stewart
J D
JD
Urschel
R A
RA
Hallgren
D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D004943:Esophagogastric Junction / Q000601:surgery; D004947:Esophagus / Q000601:surgery; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000601:surgery; D005549:Foreign-Body Reaction / Q000209:etiology / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants / Q000009:adverse effects*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome