Laparoscopic Nissen fundoplication for the management of failed Angelchik prosthesis.

BACKGROUND: Angelchik is a silicone gel-filled prosthesis that was historically placed around the gastro-esophageal junction like a horse's halter for the treatment of gastro-esophageal reflux disease. It was first described by Angelchik and Cohen in 1979, after which its usage expanded due to its simplicity and ease of insertion by open surgery. However, the use of this device has largely been abandoned due to numerous complications and a consequent high removal rate. The most common complications cited have been dysphagia, disruption, migration, and erosion into the stomach. Although many reports of Angelchik prosthesis removal have appeared in the literature, we present a case of laparoscopic removal of this device that has been inserted 25 years ago, followed immediately by Nissen fundoplication. The main indication for operation was recurrent severe reflux symptoms refractory to medical treatment.

METHODS: Case note review and literature search.

RESULTS: There was no intraoperative or postoperative complication although the procedure was extremely challenging laparoscopically primarily due to attenuated anatomy and dense adhesions. The patient made an uneventful recovery with subsequent complete resolution of symptoms.

CONCLUSION: 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.