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Angelchik


In 1973 a new device was used for the first time to reduce GERD (although not in general use until 1979). Effectively a rubber band around the oeosphagus, Angelchik would supplement the lower oesophageal sphincter and prevent reflux misery.

"It consisted of a C-shaped ring of silicon fitted around the gastroesophageal junction. The ring was secured in place by means a fitted Dacron tape. It was well favored at the time compared to other antireflux surgeries because of the simple and standardized technique of insertion of the device. Over 25,000 devices were inserted worldwide.” [r-xxxvi]

"The main advantage was the ease of insertion with low morbidity and short hospital stay. Its efficacy by 24-hour pH-metry and/or manometry was confirmed in several studies that suggested that the Angelchik ring provides early postoperative control." [r-xxxvii]

By 1984, there were signs all may not be as good as was originally thought:

"Various complications have been reported recently for the Angelchik antireflux prosthesis, a silicone-gel prosthesis used in the treatment of gastroesophageal reflux and associated hiatal hernia. We have studied the cases of 11 patients with complications of this prosthesis and have reviewed the literature for others. Complications included 8 erosions of the device into the gastrointestinal tract, 1 migration, 1 improper placement, and 1 case of pain believed to be a sequel of surgical trauma. These complications represent those typical to reflux surgery and some unique to the Angelchik prosthesis (migration and erosion). Their exact frequency is unknown, with the manufacturer estimating migration at 0.81% and erosion at 0.15%. Available data indicate that complications may occur up to several years after implantation, and physicians may not recognize the problems with the prosthesis if they are unaware of the complications.” [r-xxxviii]

"Enthusiasm for the device hugely subsided when long-term results became available. Up to 70% of patients developed moderate to severe dysphagia. In addition, other complications were frequently reported including migration of the device (due to Dacron tape failure) and erosion into surrounding structures.

By 1990, use of the Angelchik device was almost entirely abandoned and open Nissen's fundoplication became the accepted technique to treat GERD. Nowadays the laparoscopic version of this procedure is common place.” [r-xxxvi]