Laparoscopic removal of an Angelchik prosthesis

The use of Angelchik prosthetic rings for the surgical treatment of gastroe sophageal reflux disease has been associated with frequent complications, i ncluding dysphagia and migration, erosion, or disruption of the ring. Altho ugh reports of the laparoscopic insertion of Angelchik rings have been publ ished, 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 dysph agia 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 f rom the proximal stomach, diaphragm, and liver. The fibrous pseudocapsule e nclosing the ring was divided, and the prosthesis was removed from around t he esophagus and abdominal cavity. Intraoperative upper endoscopy confirmed resolution of the esophageal stricture. There were no intraoperative compl ications, and the patient was discharged home on the 3rd postoperative day tolerating a regular diet. Postoperatively, she experienced resolution of h er dysphagia and complained only of mild reflux symptoms, which were easily controlled with famotidine and antireflux precautions. This case suggests Case report that laparoscopic removal of Angelchik prosthetic rings is feas ible for surgeons familiar with advanced laparoscopic procedures of the eso phageal hiatus and should be considered for symptomatic patients, even if t he ring was inserted via an open operation.