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Reoperation for complications of the Angelchik antireflux prosthesis
K C Stewart1, J D Urschel, R A Hallgren
1Department of Surgery, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Abstract:
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.
Insights
Reoperations for Angelchik antireflux prosthesis complications are feasible. Combining prosthesis removal with fundoplication significantly reduces recurrent reflux compared to removal alone.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Medical Device Complications
Background:
- The Angelchik antireflux prosthesis is linked to complications requiring reoperation in 5-15% of patients.
- Reoperation aims to address issues like dysphagia, recurrent reflux, and device migration.
Purpose of the Study:
- To evaluate the morbidity and success rates of reoperations for Angelchik prosthesis complications.
- To compare outcomes of different reoperation strategies.
Main Methods:
- Retrospective review of 15 patients undergoing reoperation for Angelchik prosthesis complications.
- Analysis of indications for reoperation, procedures performed, and patient outcomes.
Main Results:
- Reoperation indications included dysphagia, recurrent reflux, and prosthesis migration.
- 10 patients had prosthesis removal with fundoplication; 4 had removal without it.
- Recurrent reflux was significantly higher (75%) after removal without fundoplication versus with it (10%).
- Complications included iatrogenic splenic injury (13%) and intraoperative transfusions (27%).
Conclusions:
- Reoperation for Angelchik prosthesis complications is technically challenging but offers acceptable morbidity and mortality.
- Performing an antireflux procedure (fundoplication) during prosthesis removal is crucial for successful outcomes and preventing recurrent reflux.