Laparoscopic removal of an Angelchik prosthesis

Abstract

The use of Angelchik prosthetic rings for the surgical treatment of gastroesophageal reflux disease has been associated with frequent complications, including dysphagia and migration, erosion, or disruption of the ring. Although reports of the laparoscopic insertion of Angelchik rings have been published, there have been no descriptions of the laparoscopic removal of rings inserted at open laparotomy. Our group recently removed an Angelchik ring laparoscopically in an 80-year-old woman with progressive, refractory dysphagia and esophageal narrowing due to an Angelchik ring originally placed in 1981 via an upper midline incision at open operation. Upper endoscopy and dilatation had failed to provide symptom relief. An extensive adhesiolysis was performed laparoscopically, and the Angelchik ring was dissected free from the proximal stomach, diaphragm, and liver. The fibrous pseudocapsule enclosing the ring was divided, and the prosthesis was removed from around the esophagus and abdominal cavity. Intraoperative upper endoscopy confirmed resolution of the esophageal stricture. There were no intraoperative complications, and the patient was discharged home on the 3rd postoperative day tolerating a regular diet. Postoperatively, she experienced resolution of her dysphagia and complained only of mild reflux symptoms, which were easily controlled with famotidine and antireflux precautions. 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.

Laparoscopic Transgastric Removal of an Eroded Angelchik Prosthesis

“…8,9 The first laparoscopic removal of an Angelchik prosthesis was published by Underwood and colleagues. 10 In this report, the prosthesis had not eroded into the gastric lumen, rather, the patient had severe dysphagia necessitating removal. The prosthesis was removed by simply opening the fibrous capsule surrounding the prosthesis outside of the stomach.…”

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

“…Due to its high complication rate, many patients underwent removal of the AD 2 7 12 13. Recent literature has reported successful removal of AD laparoscopically.…”

“…Recent literature has reported successful removal of AD laparoscopically. Underwood et al 13 described the resolution of dysphagia in a patient who continued to have only mild reflux symptoms following laparoscopic removal of AD. 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.…”