The Angelchik Antireflux Prosthesis

James A. Sapala, MD; M. Andrew Sapala, MD
JAMA. 1987;257(8):1050. doi:10.1001/jama.1987.03390080040020.
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To the Editor.—  We read with interest the recent Diagnostic and Therapeutic Technology Assessment (DATTA) report1 on the Angelchik antireflux prosthesis. As surgeons who implant the prosthesis on a weekly basis, we believe that implantation should not be performed routinely by surgeons unfamiliar with the finer anatomy of the infradiaphragmatic esophagus. However, we do not agree with the panelists' conclusion that concerns about the safety of the device "compromise its clinical utility."In our six-year clinical series,2 which represents the implantation of 410 Angelchik prostheses, there have been no instances of migration while using the improved device with the single circumferential strap (available after the spring of 1982). In addition, the problem of erosion has been eliminated by doing minimal dissection at the level of the lower esophageal sphincter coupled with an anterior fundal gastropexy.Further, the major problem following implantation and one that affects many more patients


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