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.