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July 1992

The Antireflux Prosthesis

Author Affiliations

Phoenix, Ariz

Arch Surg. 1992;127(7):867. doi:10.1001/archsurg.1992.01420070135025

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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

Maddern GJ, Myers JC, McIntosh N, Bridgewater FHG, Jamieson GG.  The effect of the Angelchik prosthesis on esophageal and gastric function . Arch Surg . 1991;126:1418-1422.Article
Angelchik PD, Angelchik JP.  The Angelchik prosthesis . In: Simmons RL, ed. Debates in Clinical Surgery . St Louis, Mo: Mosby—Year Book; 1991:98-122.
Sapala JA, Sapala MA, Riddle JM.  The Angelchik antireflux prosthesis: clinical and electron microscopic findings in 352 patients . In: Starling JR, ed. Reflux Esophagitis and the Angelchik Prosthesis . New York, NY: Elsevier Science Publishing Co Inc; 1987:122-149.
Gear NWL, Gillison EW, Dowling BL.  Randomized prospective trial of the Angelchik antireflux prosthesis . Br J Surg . 1984;81:681-683.Article