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. 1. Introduction There are several methods for the ligation of structures during minimally invasive operations. Many studies have examined the efficacy and safety of various devices in different situations. Each technique has potential drawbacks. Application of end loops requires dexterity and training. Titanium clips can slip from their primary position [1, 2]. New technology has played an important role in the proliferation of laparoscopy. A central issue that remains is meticulous hemostasis, particularly for larger vessels [2]. Despite their increasing popularity and widespread use, there has been a paucity of data when objectively comparing the relative safety and efficacy of these devices. There are potential disadvantages of energy-based instruments for hemostasis including lateral thermal spread, variable burst pressures, and the generation of smoke, vapor, and particulates which may compromise visibility [3]. The Hem-o-Lok clip (Weck Closure Systems, Research Triangle Park, NC, USA) was introduced in 1999 (Figure 1). This nonabsorbable polymer clip has a lock engagement feature as well as teeth in the jaws that provide good security. In addition, recent experimental studies have tested the ability of the Hem-o-Lok to withstand pressures in comparison with other devices [2, 3]. This clip has gained popularity among laparoscopic urologists for the ligation of the renal hilum vessels during minimally invasive nephrectomy. Many others have also adopted the Hem-o-Lok for a variety of laparoscopic procedures in recent years [4]. Figure 1: The Hem-o-Lok clip and its applier. 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 [5, 6]. Skeletonization of Calot’s
References
[1]
A. Aminian and Z. Khorgami, “Hem-O-Lok clip is safe in minimally invasive general surgery: a single center experience and review of data from food and drug administration,” Journal of Minimally Invasive Surgical Sciences, vol. 1, no. 2, pp. 8–13, 2012.
[2]
M. V. Meng, “Reported failures of the polymer self-locking (Hem-o-lok) clip: review of data from the Food and Drug Administration,” Journal of Endourology, vol. 20, no. 12, pp. 1054–1057, 2006.
[3]
F. C. Jellison, D. D. Baldwin, K. A. Berger, L. J. Maynes, and P. J. Desai, “Comparison of nonabsorbable polymer ligating and standard titanium clips with and without a vascular cuff,” Journal of Endourology, vol. 19, no. 7, pp. 889–893, 2005.
[4]
L. Ponsky, E. Cherullo, A. Moinzadeh et al., “The Hem-o-Lok clip is safe for laparoscopic nephrectomy: a multi-institutional review,” Urology, vol. 71, no. 4, pp. 593–596, 2008.
[5]
L. Yahui, J. Bai, W. Yingchao, and W. Guangyi, “Hem-o-lok clip found in common bile duct after laparoscopic cholecys-tectomy and common bile duct exploration: a clinical analysis of 8 cases,” International Journal of Medical Sciences, vol. 9, no. 3, pp. 225–227, 2012.
[6]
A. Cuschier and J. Terblanche, “Laparoscopic cholecystectomy: evolution, not revolution,” Surgical Endoscopy, vol. 4, no. 3, pp. 125–126, 1990.
[7]
N. Ay, B. Dine, A. Dinckan, V. T. Yilmaz, O. Erdogan, and A. Gurkan, “The safety of hem-o-lock clips at donor nephrectomies,” Annals of Transplantation, vol. 15, no. 1, pp. 36–39, 2010.
[8]
V. H. Chong and C. F. Chong, “Biliary complications secondary to post-cholecystectomy clip migration: a review of 69 cases,” Journal of Gastrointestinal Surgery, vol. 14, no. 4, pp. 688–696, 2010.
[9]
J. S. Yi, C. Kwak, H. H. Kim, and J. H. Ku, “Surgical clip-related complications after radical prostatectomy,” Korean Journal of Urology, vol. 51, no. 10, pp. 683–687, 2010.
[10]
S. E. Gurtcheff, “Introduction to the MAUDE database,” Clinical Obstetrics and Gynecology, vol. 51, no. 1, pp. 120–123, 2008.
[11]
US Food and Drug Administration, “Manufacturer and User Facility Device Experience Database-(MAUDE),” 2011, http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/PostmarketRequirements/ReportingAdverseEvents/default.htm.
[12]
S. D. Wu, R. R. Rios, J. J. Meeks, and R. B. Nadler, “Rectal Hem-o-Lok clip migration after robot-assisted laparoscopic radical prostatectomy,” The Canadian Journal of Urology, vol. 16, no. 6, pp. 4939–4940, 2009.
[13]
R. L. Moser and N. Narepalem, “Erosion of hem-o-lok clips at the bladder neck after robot-assisted radical prostatectomy,” Journal of Endourology, vol. 23, no. 6, pp. 949–951, 2009.
[14]
G. J. Tunnard and C. S. Biyani, “An unusual complication of a Hem-o-Lok Clip following laparoscopic radical prostatectomy,” Journal of Laparoendoscopic and Advanced Surgical Techniques, vol. 19, no. 5, pp. 649–651, 2009.
[15]
V. Tugcu, H. Polat, B. Ozbay, G. A. Eren, and A. I. Tasci, “Stone formation from intravesical Hem-o-lok clip migration after laparoscopic radical prostatectomy,” Journal of Endourology, vol. 23, no. 7, pp. 1111–1113, 2009.
[16]
E. R. Mora, O. B. Galí, J. A. L. Garin, and O. Arango, “Intravesical migration and spontaneous expulsion of a Hem-o-lok polymer ligating clip after laparoscopic radical prostatectomy,” Urology, vol. 75, no. 6, p. 1317, 2010.
