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Liu HY, Yin AH, Wei Z. Hem-o-lok clip migration to duodenal bulb post-cholecystectomy: A case report. World J Gastrointest Surg 2024; 16:1461-1466. [PMID: 38817275 PMCID: PMC11135296 DOI: 10.4240/wjgs.v16.i5.1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/13/2024] [Accepted: 04/10/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Hem-o-lok clips are typically used to control the cystic duct and vessels during laparoscopic cholecystectomy (LC) and common bile duct exploration for stones in the bile duct and gallbladder. Here, we report a unique example of Hem-o-lok clip movement towards the duodenal bulb after LC, appearing as a submucosal tumor (SMT). Additionally, we provide initial evidence of gradual and evolving endoscopic manifestations of Hem-o-lok clip migration to the duodenal bulb wall and review the available literature. CASE SUMMARY A 72-year-old man underwent LC for gallstones, and Hem-o-lok clips were used to ligate both the cystic duct and cystic artery. Esophagogastroduodenoscopy (EGD) 2 years later revealed an SMT-like lesion in the duodenal bulb. Due to the symptomatology, the clinical examination did not reveal any major abnormalities, and the patient was followed up as an outpatient. A repeat EGD performed 5 months later revealed an SMT-like lesion in the duodenal bulb with raised edges and a central depression. A third EGD was conducted, during which a Hem-o-lok clip was discovered connected to the front side of the duodenum. The clip was extracted easily using biopsy forceps, and no complications occurred. Two months after the fourth EGD, the scar was surrounded by normal mucosa. CONCLUSION Clinicians should be aware of potential post-LC complications. Hem-o-lok clips should be removed if symptomatic.
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Affiliation(s)
- Hong-Yan Liu
- Department of Gastroenterology, Shandong Second Provincial General Hospital, Jinan 250022, Shandong Province, China
| | - Ai-Hong Yin
- Department of Gastroenterology, Shandong Second Provincial General Hospital, Jinan 250022, Shandong Province, China
| | - Zhi Wei
- Department of Gastroenterology, Shandong Second Provincial General Hospital, Jinan 250022, Shandong Province, China
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2
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Liu DR, Wu JH, Shi JT, Zhu HB, Li C. Hem-o-lok clip migration to the common bile duct after laparoscopic common bile duct exploration: A case report. World J Clin Cases 2022; 10:6548-6554. [PMID: 35979320 PMCID: PMC9294917 DOI: 10.12998/wjcc.v10.i19.6548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/18/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) has been widely used for management of gallbladder and common bile duct (CBD) stones. Post-operative clip migration is a rare complication of laparoscopic biliary surgery, which can serve as a nidus for stone formation and cause recurrent cholangitis.
CASE SUMMARY A 59-year-old female was admitted to hospital because of fever and acute right upper abdominal pain. She has a history of LC and had a LCBDE surgery 2 mo ago. Physical examination revealed tenderness in the upper quadrant of right abdomen. Computed tomography scan demonstrated a high-density shadow at the distal CBD, which was considered as migrated clips. The speculation was confirmed by endoscopic retrograde cholangiopancreatography examination, and two displaced Hem-o-lok clips were removed with a stone basket. No fever or abdominal pain presented after the operation. In addition to the case report, literature regarding surgical clip migration after laparoscopic biliary surgery was reviewed and discussed.
CONCLUSION Incidence of postoperative clip migration may be reduced by using clips properly and correctly; however, new methods should be explored to occlude cystic duct and vessels. If a patient with a past history of LC or LCBDE presents with features of sepsis and recurrent upper quadrant pain, clip migration must be considered as one of the differential diagnosis.
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Affiliation(s)
- Da-Ren Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jin-Hong Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jiang-Tao Shi
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Huan-Bing Zhu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Chao Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
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Kihara Y, Takeda Y, Ohmura Y, Katsura Y, Shinke G, Ikeshima R, Katsuyama S, Kawai K, Hiraki M, Sugimura K, Masuzawa T, Takeno A, Hata T, Murata K. Migration of non-absorbable polymer clips in hepato-biliary-pancreatic surgery: a report of four cases. Surg Case Rep 2021; 7:183. [PMID: 34390417 PMCID: PMC8364615 DOI: 10.1186/s40792-021-01269-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Ligation clips are used for vessel or tissue ligation in surgery. Although previous reports have described the migration of metallic clips after hepato-biliary-pancreatic surgery, very few reports have described the migration of non-absorbable polymer clips (NAPCs: Hem-o-Lok). Case presentation We present 4 cases of NAPC migration that occurred after laparoscopic surgery. Case 1 was an 81-year-old woman that had undergone a laparoscopic right hemihepatectomy for an intrahepatic bile duct cyst adenocarcinoma at the age of 79 years. Two years after the operation, she underwent an upper gastrointestinal endoscopy to investigate epigastric pain. The endoscopy showed NAPCs lodged at the anterior side of the duodenal bulb. Case 2 was an 80-year-old man that had undergone a laparoscopic cholecystectomy for choledocholithiasis at the age of 77 years. Three years after the operation, follow-up computed tomography and magnetic resonance cholangiopancreatography (MRCP) imaging indicated a mass in the upper bile duct. After a laparoscopic bile duct resection and reconstruction, an NAPC was found inside the inflammatory pseudotumor. Case 3 was a 63-year-old man that had undergone laparoscopic liver S4b and S5 resections and lymph node dissection for gallbladder cancer. Three months after the operation, follow-up MRCP imaging suggested a bile duct stenosis. An endoscopic retrograde cholangiopancreatography (ERCP) was performed, and an NAPC was found inside the bile duct. Case 4 was a 74-year-old man that had undergone a laparoscopic S5 segmentectomy, S7 partial liver resection, and cholecystectomy for liver metastasis of lung cancer and cholelithiasis. A trans-cystic drainage tube was inserted, and it was ligated and fixed with NAPCs. Three months after the operation, follow-up MRCP imaging showed common bile duct stones (CBDS). An ERCP was performed, and two NAPCs were found with the CBDS. Conclusions Few previous reports have described complications due to NAPC migration after hepato-biliary-pancreatic surgery. However, with the widespread use of NAPC, postoperative complications due to NAPC migration are expected to increase in the near future. The differential diagnosis of complications should include potential NAPC migration in patients that have undergone laparoscopic surgery.
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Affiliation(s)
- Yukari Kihara
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Yoshiaki Ohmura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yoshiteru Katsura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Go Shinke
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Ryo Ikeshima
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Shinsuke Katsuyama
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kenji Kawai
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Masayuki Hiraki
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Keijiro Sugimura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Toru Masuzawa
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Taishi Hata
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kohei Murata
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
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Pantoja Pachajoa DA, Bruno MA, Doniquian AM, Alvarez FA. Titanium clip migration after cholecystectomy: original technique for laparoscopic transcystic extraction when endoscopic retrograde cholangiopancreatography fails. J Surg Case Rep 2020; 2020:rjaa289. [PMID: 32939240 PMCID: PMC7482979 DOI: 10.1093/jscr/rjaa289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 11/13/2022] Open
Abstract
Surgical clip migration into the common bile duct (CBD) is a rare complication after laparoscopic cholecystectomy (LC). Few cases of surgical clip migration have been reported in the literature, and most of them have been successfully treated with endoscopic retrograde cholangiopancreatography (ERCP). We present a 71-year-old woman with 48 h of abdominal pain, jaundice and fever 6 years after laparoscopic cholecystectomy. She was diagnosed with common bile duct obstruction from surgical clip migration. After failure of ERCP, the patient was successfully treated with an innovative approach by laparoscopic transcystic extraction using endoscopic hose-type biopsy forceps. The presented technique was feasible and safe in expert hands, representing a valuable alternative to avoid the need of a choledochotomy in patients with unsuccessful ERCP.
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Affiliation(s)
- Diana A Pantoja Pachajoa
- Hepato-Pancreato-Biliary Surgery Section, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Marco A Bruno
- Hepato-Pancreato-Biliary Surgery Section, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Alejandro M Doniquian
- Hepato-Pancreato-Biliary Surgery Section, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Fernando A Alvarez
- Hepato-Pancreato-Biliary Surgery Section, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
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Ng DYL, Petrushnko W, Kelly MD. Clip as Nidus for Choledocholithiasis after Cholecystectomy-Literature Review. JSLS 2020; 24:JSLS.2019.00053. [PMID: 32161435 PMCID: PMC7044717 DOI: 10.4293/jsls.2019.00053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background and Objectives Foreign material in the biliary tree may serve as a nidus for stone formation and would usually present as choledocholithiasis with jaundice or cholangitis. Overall it is a rare occurrence, but there are many anecdotal reports of ingested matter or surgical material such as suture or clips causing biliary stones. Especially interesting are the cases in which there is migration of a metallic clip used in laparoscopic cholecystectomy. Cholecystectomy is such a common operation that although the phenomenon is rare, it is important because it is preventable, and as such a review of the topic seems worthwhile. Methods The available literature was searched using the EMBASE and Ovid databases and reviewed. The various devices and sutures used to occlude the cystic duct in laparoscopic cholecystectomy are discussed with reference to their safety. Results and Conclusion We found that the harmonic scalpel is a reasonable alternative with minimal complications but is however limited by cost. Electrosurgical vessel-sealing, ultrasonic shears, absorbable sutures such as endoloops (PDS), and polymer clips as well absorbable magnesium-calcium-zinc alloy clip are discussed.
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Affiliation(s)
- Daniel Yee Lee Ng
- Department of Surgery, Albury Wodonga Health, Albury, NSW, Australia
| | - Wilson Petrushnko
- Department of Surgery, Albury Wodonga Health, Albury, NSW, Australia
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Barabino M, Luigiano C, Piccolo G, Pellicano R, Polizzi M, Giovenzana M, Santambrogio R, Pisani Ceretti A, Andreatta E, Palamara MA, Giacobbe G, Consolo P, Opocher E. Hem-o-Lok clip migration into the duodenum after laparoscopic digestive surgery: a systematic review. MINERVA CHIR 2020; 74:496-500. [PMID: 31958943 DOI: 10.23736/s0026-4733.19.08152-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The wide use of hemoclips during laparoscopic surgery has led to a variety of unusual complications, among these, there is the migration of Hem-o-Lok clip into the duodenum. We performed a literature review of all cases of Hem-o-Lok clip migration into the duodenum after laparoscopic digestive surgery reported in literature. EVIDENCE ACQUISITION All relevant articles were extracted up to June 2019 based on the results of searches in MEDLINE, PubMed, Scopus, Web of Science and Google Scholar. EVIDENCE SYNTHESIS At the time of this review, a total of seven cases have been described. The mean age was 49 years and the majority of these patients were women (57%). Previous laparoscopic surgery was performed for cholecystectomy (four patients), cholecystectomy with common bile duct exploration (one patient), right hemicolectomy (one patient) and distal gastrectomy (one patient). Symptoms occurred from 3 months to 2 years after laparoscopic surgery. The majority of patients developed symptoms of bowel occlusion and abdominal pain. Three patients remained asymptomatic. In many cases the Hem-o-Lok wedged into the wall of the first or second portion of the duodenum. In all cases, esophageal gastroduodenoscopy was the primary modality to make the diagnosis. Initial treatment was conservative with watch-and-wait strategy or proton pump inhibitors followed by endoscopic removal, while surgical treatment was required in two cases. CONCLUSIONS The application of Hem-o-Lok clip during laparoscopic surgery is safe and effective. Postoperative Hem-o-Lok migration into the duodenum is rare. The treatment could be conservative in the majority of cases.
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Affiliation(s)
- Matteo Barabino
- Unit of Hepato-biliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Gaetano Piccolo
- Unit of Hepato-biliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Rinaldo Pellicano
- Department of Gastroenterology, Molinette-S. Giovanni Antica Sede Hospital, Turin, Italy
| | - Micol Polizzi
- Unit of Hepato-biliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Marco Giovenzana
- Unit of Hepato-biliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Roberto Santambrogio
- Unit of Hepato-biliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Andrea Pisani Ceretti
- Unit of Hepato-biliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Erika Andreatta
- Unit of Hepato-biliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Giuseppa Giacobbe
- Unit of Digestive Endoscopy, G. Martino Hospital, University of Messina, Messina, Italy
| | - Pierluigi Consolo
- Unit of Digestive Endoscopy, G. Martino Hospital, University of Messina, Messina, Italy
| | - Enrico Opocher
- Unit of Hepato-biliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
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Roh YJ, Kim JW, Jeon TJ, Park JY. Common bile duct stone development due to a Hem-o-lok clip migration: a rare complication of laparoscopic cholecystectomy. BMJ Case Rep 2019; 12:12/7/e230178. [PMID: 31352393 DOI: 10.1136/bcr-2019-230178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Surgical clip migration is a rare complication of laparoscopic cholecystectomy (LC). Surgical clips migrating into the common bile duct (CBD) can lead to stone formation and obstruction. Here, we report a case of acute cholangitis caused by surgical Hem-o-lok clip migration into the bile duct with stone formation 13 months after LC. A 65-year-old man who underwent LC presented with upper abdominal pain and fever for 3 days. Abdominal CT scan showed a radiopaque material in the CBD, diffuse wall thickening and dilatation of intrahepatic and extrahepatic duct. Emergency percutaneous transhepatic biliary drainage was performed. Twodays later, an endoscopic retrograde cholangio-pancreatography was implemented, and muddy stones and one surgical clip were successfully removed by extraction balloon catheter.
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Affiliation(s)
- Yong Jun Roh
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Korea
| | - Jong Whan Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Korea
| | - Tae Joo Jeon
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Korea
| | - Ji Young Park
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Korea
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8
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Rou WS, Joo JS, Kang SH, Moon HS, Kim SH, Sung JK, Lee BS, Lee ES. [Abdominal Pain Due to Hem-o-lok Clip Migration after Laparoscopic Cholecystectomy]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 72:313-317. [PMID: 30642151 DOI: 10.4166/kjg.2018.72.6.313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 11/03/2022]
Abstract
During laparoscopic cholecystectomy, a surgical clip is used to control the cystic duct and cystic artery. In the past, metallic clips were usually used, but over recent years, interest in the use of Hem-o-lok clips has increased. Surgical clip migration into the common bile duct (CBD) after laparoscopic cholecystectomy has rarely been reported and the majority of reported cases involved metallic clips. In this report, we describe the case of a 53-year-old woman who presented with abdominal pain caused by migration of a Hem-o-lok clip into the CBD. The patient had undergone laparoscopic cholecystectomy 10 months previously. Abdominal CT revealed an indistinct, minute, radiation-impermeable object in the distal CBD. The object was successfully removed by sphincterotomy via ERCP using a stone basket and was identified as a Hem-o-lok clip.
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Affiliation(s)
- Woo Sun Rou
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jong Seok Joo
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Hyung Kang
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hee Seok Moon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seok Hyun Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Byung Seok Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Eaum Seok Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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Kou K, Liu X, Hu Y, Luo F, Sun D, Wang G, Li Y, Chen Y, Lv G. Hem-o-lok clip found in the common bile duct 3 years after laparoscopic cholecystectomy and surgical exploration. J Int Med Res 2019; 47:1052-1058. [PMID: 30616484 PMCID: PMC6381503 DOI: 10.1177/0300060518817216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction is a common and preferred choice for gallstone disease. Laparoscopic common bile duct exploration (LCBDE) and laparoscopic cholecystectomy (LC) are being increasingly used for managing choledocholithiasis and cholecystolithiasis. We report a case of a Hem-o-lok clip that was dropped into the common bile duct (CBD) after LC and surgical common bile duct exploration (CBDE). An 84-year-old man presented with right upper quadrant pain and jaundice for 2 months, and chills and hyperpyrexia for 1 day. The patient had received ERCP and surgical CBDE at a local hospital 3 years previously. The patient first received ERCP and endoscopic nasobiliary drainage (ENBD). When laboratory tests were normal, the patient then received LCBDE. During exploration, stones and a Hem-o-lok clip in the CBD were removed. The patient made good progress after LCBDE + T-tube placement and was discharged from hospital. The findings from this case suggest the following: 1) an appropriate therapy method should be considered for certain gallstone diseases, especially for choledocholithiasis and cholecystolithiasis; and 2) a Hem-o-lok clip should be carefully used during laparoscopic or robot-assisted surgery and the Hem-o-lok clip should not be in close proximity to the incision on the CBD.
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Affiliation(s)
- Kai Kou
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xingkai Liu
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yuelei Hu
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Feixiang Luo
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Dawei Sun
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Guangyi Wang
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yan Li
- 2 Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Yuguo Chen
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Guoyue Lv
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
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10
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Pang L, Yuan J, Zhang Y, Wang Y, Kong J. Clip-stone and T clip-sinus: A clinical analysis of six cases on migration of clips and literature review from 1997 to 2017. J Minim Access Surg 2019; 15:192-197. [PMID: 29794362 PMCID: PMC6561069 DOI: 10.4103/jmas.jmas_53_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction: With the development of laparoscopic skills, the laparoscopic common bile duct exploration (LCBDE) and laparoscopic cholecystectomy (LC) has become the standard surgical procedure for choledocholithiasis. We usually use Hem-o-lok clips to control cystic duct and vessels, which is safe on most occasions and has few perioperative complications such as major bleeding, wound infection, bile leakage, and biliary and bowel injury. However, a rare complication of post-cholecystectomy clip migration (PCCM) increases year by year due to the advancement and development of LC, CBD exploration as well as the wide use of surgical ligation clips. Materials and Methods: Six patients whose clips are found dropping into CBD or forming T-tube sinus after laparoscopic surgery in our department. Results: Six patients whose clips are found dropping into CBD (clip-stone) (3/6) or forming T-tube sinus (T clip-sinus) (3/6) after LCBDE or LC. Conclusions: PCCM is a rare but severe complication of LCBDE. A pre-operative understanding of bile duct anatomy, the use of the minimum number of clips and the harmonic scalpel during the surgeries is necessary. Considering clip-stone or clip-sinus in the differential diagnosis of patients with biliary colics or cholangitis after LCBDE even years after surgery, the detailed medical history and pre-operative examination are inevitable, especially for these patients who had undergone LCBDE.
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Affiliation(s)
- Liwei Pang
- Department of Biliary and Minimally Invasive Surgery, China Medical University Shengjing Hospital Shenyang, Liaoning, China
| | - Jindong Yuan
- Department of Biliary and Minimally Invasive Surgery, China Medical University Shengjing Hospital Shenyang, Liaoning, China
| | - Yan Zhang
- Department of Biliary and Minimally Invasive Surgery, China Medical University Shengjing Hospital Shenyang, Liaoning, China
| | - Yuwen Wang
- Department of Surgery, The Sixth People's Hospital of Shenyang, Liaoning, China
| | - Jing Kong
- Department of Biliary and Minimally Invasive Surgery, China Medical University Shengjing Hospital Shenyang, Liaoning, China
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11
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Zheng Y, Wang Y, Bai X, Liu D, Li F. Letter to the editor on "The cystic duct and artery were clipped using a clip applier". Nonmetal clip migration after laparoscopic cholecystectomy. Asian J Surg 2018; 41:585-587. [PMID: 30316664 DOI: 10.1016/j.asjsur.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yamin Zheng
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Yuehua Wang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Xuesong Bai
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dongbin Liu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Padmanabhan H, Wheatley D, Brookes MJ. An Unusual Cause of Postcholecystectomy Gastrointestinal Hemorrhage. Gastroenterology 2016; 150:1535-1536. [PMID: 27140486 DOI: 10.1053/j.gastro.2016.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/11/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Hari Padmanabhan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Daniel Wheatley
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Matthew J Brookes
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
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Yu CC, Yang CK, Ou YC. Three Types of Intravesical Hem-o-Lok Clip Migration After Laparoscopic Radical Prostatectomy. J Laparoendosc Adv Surg Tech A 2015; 25:1005-8. [PMID: 26566082 DOI: 10.1089/lap.2015.0150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hem-o-Lok® clips (HOLCs) (Weck® Surgical Instruments, Teleflex Medical, Durham, NC) are widely used for controlling the lateral pedicles in laparoscopic radical prostatectomy, but intravesical HOLC migrations have been reported in more and more studies. This study aimed to summarize clinical presentations, management, and outcomes of these patients. MATERIALS AND METHODS Six patients with intravesical HOLC migration were retrospectively identified from 750 consecutive patients who underwent robot-assisted laparoscopic prostatectomy between 2005 and 2014 performed by a single surgeon. The PubMed database was also searched for Hem-o-Lok clip migration after laparoscopic prostatectomy. RESULTS The incidence of intravesical HOLC migration in this study was 0.8% (6/750). In total, 22 patients were reported, including six from the current series. Three types of migrations were classified: Type I migration resulted in obstructive lower urinary tract symptoms 2-8 months after prostatectomy, whereas Type II migration led to stone formation, gross hematuria, or bladder spasm; in Type III migration, patients had spontaneous expulsion of the HOLC weeks after surgery. CONCLUSIONS Although the incidence of intravesical HOLC migration is relatively low, Type I migration with long-term sequelae remains a concern. The use of HOLCs adjacent to anastomosis should be minimized, and any loose clip must be retrieved to reduce complications.
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Affiliation(s)
- Chih-Chin Yu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan, Republic of China
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan, Republic of China
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan, Republic of China
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Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G, Barlera S, Davoli M. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbecks Arch Surg 2015; 400:429-53. [PMID: 25850631 DOI: 10.1007/s00423-015-1300-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/24/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the gold standard technique for gallbladder diseases in both acute and elective surgery. Nevertheless, reports from national surveys still seem to represent some doubts regarding its diffusion. There is neither a wide consensus on its indications nor on its possible related morbidity. On the other hand, more than 25 years have passed since the introduction of LC, and we have all witnessed the exponential growth of knowledge, skill and technology that has followed it. In 1995, the EAES published its consensus statement on laparoscopic cholecystectomy in which seven main questions were answered, according to the available evidence. During the following 20 years, there have been several additional guidelines on LC, mainly focused on some particular aspect, such as emergency or concomitant biliary tract surgery. METHODS In 2012, several Italian surgical societies decided to revisit the clinical recommendations for the role of laparoscopy in the treatment of gallbladder diseases in adults, to update and supplement the existing guidelines with recommendations that reflect what is known and what constitutes good practice concerning LC.
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Affiliation(s)
- Ferdinando Agresta
- Department of Surgery, Presidio Ospedaliero di Adria (RO), Adria, RO, Italy,
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Hem-o-Lok Clip in the First Part of Duodenum after Laparoscopic Cholecystectomy. Case Rep Gastrointest Med 2013; 2013:251634. [PMID: 23738158 PMCID: PMC3664476 DOI: 10.1155/2013/251634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/09/2013] [Indexed: 01/18/2023] Open
Abstract
Laparoscopic cholecystectomy (LC) and common bile duct exploration (LCBDE) have become the standard surgical procedure for cholecystolithiasis and choledocholithiasis. During the operation, cystic duct and vessels are usually controlled by Hem-o-Lok clips. We report a case with a complaint of severe abdominal pain for the previous 20 days. Her medical history was unremarkable except for laparoscopic cholecystectomy 8 months ago. In upper gastrointestinal endoscopy, two Hem-o-Lok clips at anterior wall of the first part of duodenum were detected. Therefore, the clip can migrate during postoperative period and Hem-o-Lok is not a very safe ligation method during laparoscopic cholecystectomy.
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