Clip as Nidus for Choledocholithiasis after Cholecystectomy—Literature Review

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.

Primary Choledocholithiasis 15 Years Postcholecystectomy

“…ere have been only a few case reports of postcholecystectomy bile duct stones occurring more than 10 years following surgery in the literature. Most of these reports describe the presence of stones within the gallbladder/cystic duct remnant or secondary to migrating surgical clips [4,5].We report a unique case of intra-and extrahepatic choledocholithiasis 15 years following laparoscopic cholecystectomy secondary to a primary biliary stone.…”

Acute Cholangitis Secondary to Surgical Clip Migration 18 Years After Cholecystectomy: A Case Report

“…Postcholecystectomy clip migration (PCCM) was first reported in 1979 after open cholecystectomy and in 1992 after laparoscopic cholecystectomy [3,4]. As the number of cholecystectomies performed increased over the years [5], the number of cases of PCCM reported has also increased and continued to be reported [6][7][8]. A literature search of publications in English and non-English has yielded mainly case reports or case series with only two publications that had analyzed and summarized the published cases.…”

The Outcomes of the Patients Undergoing Harmonic Scalpel Laparoscopic Cholecystectomy

“…Many studies and reports have shown that the clips do not lead to complete closure of the cystic duct and can slide down, leading to leakage of bile both intra-operatively and post-operatively. Many studies have shown that the clip can act as a nidus for subsequent stone formation [6,8].…”

“…Abounozha et al have already done studies that showed that the risk of bile leakage and intra-operative bleeding in HSC is comparatively less compared to electrocoagulation [4,5]. Ng et al have done a literature review about the titanium clip, which is usually used in electrocoagulation, acting as a nidus for stone formation for choledocholithiasis [6]. Schreuder et al and Angelescu et al have also reported similar cases of clips acting as a nidus for stone formation [7,8].…”