Angelchik Repair

Designed by Angelchik and Cohen in 1979, the principle is to wrap a silicone rubber collar around the esophagus and stomach junction to restrain the site and resist backflow. So far, 25,000 cases have been implemented in the world. The Angelchik ring is a "C" shaped collar, hollow, with a wall thickness of 0.4mm, filled with silicone, colorless and transparent. The outer diameter is 7.0cm at the widest point and the inner diameter is 2.5cm. Two straps are attached at both ends for intraoperative fixation (Fig. 5.6.4.1.5-1). The outer edge of the ring is provided with an X-ray-permeable marker that shows its position under radiation. Treatment of diseases: reflux esophagitis preoperative preparation 1. Diet therapy, acid-resistant treatment, bed elevation 20 ° during sleep, so that reflux esophagitis is in a stable state. 2. Correct anemia and hypoproteinemia before surgery. 3. Control airway inflammation and stop smoking. 4. Lower stomach tube before surgery. Surgical procedure 1. The median or median midline incision in the upper abdomen. 2. Incision of the esophageal membrane, exposure of the lower esophagus and gastric fundus, such as the left hepatic lobe obstructing the surgical field can cut the liver ligament. 3. Insert the left hand finger into the posterior part of the esophagus, and pull the ligament of the Angelchik circle with a right angle pliers, so that it is placed on the abdomen of the esophagus. After the ends of the Angelchik circle are aligned, tie the tie in front of the esophagus. The suture is tied with a silk thread to prevent loosening, but the ligation cannot be too tight. complication 1. The repair ring is knotted loose, causing recurrence of gastroesophageal reflux. 2. The repair ring is still at the level of the lower esophageal sphincter, but the lower esophageal sphincter and the upper part of the stomach slide into the chest through the large and loose cleft palate. 3. The repair ring slides down from the bottom of the stomach. 4. An ulcer occurs in the repaired area and penetrates into the stomach.

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