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To the Editor.—I read with interest the report by Maddern et al,1 published in the November 1991 issue of the Archives This report was instructive in two ways: first, as a study of functional physiologic parameters in a small number (n = 17) of patients undergoing antireflux prosthesis (ARP) implantation, and, more importantly, as an example of the type of poorly designed investigation that has plagued the device since its introduction.
Unfortunately, Dr Yurt's accompanying "Invited Commentary" does little to enlighten the audience to the shortcomings of the article, which are not related to the validity of the statistical analysis or accuracy of the diagnostic technology. Rather, they pertain to the small size of the cohort group, the uncontrolled nature of the study, the implicit philosophical bias of the authors against the ARP, and the tacit assumption that this technique is so simple as to preclude surgical error as
ANGELCHIK J. The Antireflux Prosthesis. Arch Surg. 1992;127(7):867. doi:10.1001/archsurg.1992.01420070135025