Hem-o-lok Clips Migration: An Easily Neglected Complication after Laparoscopic Biliary Surgery

Abstract

Clip migration into the common bile duct (CBD) is a rare but well-established phenomenon of laparoscopic biliary surgery. The mechanism and exact incidence of clip migration are both poorly understood. Clip migration into the common bile duct can cause recurrent cholangitis and serve as a nidus for stone formation. We present a case, a 54-year-old woman, of clip-induced cholangitis resulting from surgical clip migration 12 months after laparoscopic cholecystectomy and laparoscopic common bile duct exploration (LC+LCBDE) with primary closure.

Common bile duct stone development due to a Hem-o-lok clip migration: a rare complication of laparoscopic cholecystectomy

“…The clinical manifestations of PCCM include abdominal pain, jaundice, fever, nausea and vomiting, which were not different from non-iatrogenic choledocholithiasis 6. Acute pancreatitis, duodenal ulcer or biliary-colonic fistula have been noted with PCCM 2 11. The median time from cholecystectomy to clinical recognition of PCCM was 26 months (range, 11 days to 20 years) 2 11.…”

“…Acute pancreatitis, duodenal ulcer or biliary-colonic fistula have been noted with PCCM 2 11. The median time from cholecystectomy to clinical recognition of PCCM was 26 months (range, 11 days to 20 years) 2 11. The ERCP is currently the treatment of choice for PCCM with an 84.5% success rate 2 4…”

“…Laparoscopic cholecystectomy (LC) is the gold standard for the surgical management of gallstone disease 1 2. Laparoscopic surgery results in reduced postoperative pain, good cosmetic effect and short hospital stay, when compared with open cholecystectomy 3.…”

Cholangitis caused by surgical clip migration into the common bile duct: a rare complication of a daily practice

“…The exact sequence of events that lead to the migration of the clip remains unknown. Possible mechanisms include an incomplete closure of the cystic duct caused by an ineffective clip slippage, bile leak and the formation of biloma with or without infection,6 inaccurate position of the clip due to the deformity of the anatomical structures in severe inflammation,7 or placement of too many clips—more than four 4 8. Another hypothesis is that a localised inflammatory process may lead to erosion of the bile duct wall, which results in the surgical clip migrating into the ductal system 9.…”

“…ERCP is the gold standard procedure for managing these complications with success rate of almost 85% 7…”