Laparoscopic Nissen Fundoplication for the Management of Failed Angelchik Prosthesis

Abstract

Patients who have severe recurrent gastro-esophageal reflux disease symptoms refractory to medical treatment after placement of an Angelchik prosthesis can be treated by laparoscopic removal of the device followed by Nissen fundoplication.

The historical Angelchik anti‐reflux device: laparoscopic removal for dysphagia

“…Concurrent or staged fundoplication has been described with removal of the Angelchik device 6 ; our patient had no reflux symptoms. The pertinent concern was refractory stricture, however, operative division of the peri‐oesophageal scar tissue was adequate to relieve dysphagia.…”

Atypical dysphagia with end-stage oesophageal disease 30 years post Angelchik device placement in a 72-year-old man

“…Another case reported by Carbonell and Maher12 described the removal of the AD via a laparoscopic, transgastric approach to retrieve an AD that had eroded through the gastrointestinal junction. Jalil et al 14 described the laparoscopic removal of Angelchik prosthesis followed by an immediate Nissen’s fundoplication in a patient who had an AD for over 20 years 14. Others have demonstrated successful endoscopic removal of AD that had eroded through the oesophagus or created a fistula 8 11.…”

Esophagogastric Fistula Caused by an Angelchik Antireflux Prosthesis

“…In reported cases, inadequate GERD control after prosthesis placement led to subsequent Nissen fundoplication, and in 3 patients, esophageal adenocarcinoma. 12 ,13 …”