Hem-o-Lok clip migration into the duodenum after laparoscopic digestive surgery: a systematic review

Barabino, Matteo; Luigiano, Carmelo; Piccolo, Gaetano; Pellicano, Rinaldo; Polizzi, Micol; Giovenzana, Marco; Santambrogio, Roberto; Ceretti, Andrea Pisani; Andreatta, Erika; Palamara, Maria A; Giacobbe, G; Consolo, Pierluigi; Opocher, Enrico

doi:10.23736/s0026-4733.19.08152-5

Cited by 9 publications

(11 citation statements)

References 29 publications

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“…The use of Hem-o-Lok clips is well described in the adult literature in procedures such as laparoscopic cholecystectomy and laparoscopic or retroperitoneoscopic nephrectomy [9][10][11][12]. There are rare reports of clip migration into surrounding viscera [13,14] which have not been documented in the paediatric population but should remain an important consideration. We acknowledge the short duration of follow-up to date but note that no patients in this study have reported symptoms post-operatively that could be attributable to clip migration.…”

Section: Discussionmentioning

confidence: 99%

Hem-o-Lok polymer clips for major vascular control in paediatric minimally invasive surgery

et al. 2021

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Purpose The challenge of endoscopic large vessel control has brought sweat to the brow of many a surgeon, yet the optimal method for use in a small working space remains unknown. Reports of delayed, major haemorrhage with exclusive energy device use have raised significant concerns. We, therefore, report outcomes of an alternative sealing device (Weck Hem-o-Lok polymer clips) in laparoscopic and thoracoscopic surgery. Methods A retrospective review of all patients (< 18 years) who underwent laparoscopic splenectomy or thoracoscopic pulmonary resection between February 2018 and August 2020 (30 months) was undertaken. Data are presented as median (IQR). Results Thirty-three patients were identified (16 female); 16 underwent laparoscopic splenectomy and 17 thoracoscopic lobectomy/excision of congenital pulmonary airway malformation (CPAM) or resection of pulmonary sequestration. Age at surgery was 7 years 7 months (6 years 2 months–9 years 9 months) and weight 23.0 kg (20.2–37.4 kg) in the splenectomy group: it was 16 months (13–19 months) and 12.0 kg (10.4–13.2 kg) in the thoracic group. Hem-o-Lok clips (medium–large) were used to individually clip: (1) the main splenic artery and vein; or (2) pulmonary arterial branches and vein; or (3) systemic sequestration vessels, using a 5 mm endoscopic applicator. In most cases, two clips were placed proximally and one distally: the vessel then divided without energy. There were no incidences of clip failure during application or migration. There was no significant intra-operative or post-operative bleeding. Conclusion Hem-o-Lok polymer clips are a safe and reliable method for major vascular control during endoscopic surgery in small children.

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Section: Discussionmentioning

confidence: 99%

Hem-o-Lok polymer clips for major vascular control in paediatric minimally invasive surgery

et al. 2021

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“…When assessing the pros and cons of MC, we must consider the risks of mesenteric hemorrhage, devascularization of the bowel and kinking of the anastomosis. Using polymerligating clips, we have had no intra-or postoperative complications attributable to the technique, but it is reasonable to suppose that the proposed technique may potentially result in complications such as hematoma, bleeding or ischemia and can be responsible for formation of adhesions due to foreign body reaction or migration [24,25]. However, the perceived impression is that of a simple technique: it is certainly necessary to pay attention to where the clips are placed to avoid vessels occlusion, but, in case of misplacement, these clips can be removed without much effort and repositioned after accurate alignment of the two limbs of tissue.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric closure with polymer-ligating clips after right colectomy with complete mesocolic excision for cancer and mesentery-based ileocolic resection for Crohn’s disease

et al. 2021

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Mesenteric closure following right colectomy remains controversial and, following the advent of laparoscopic surgery, many surgeons do not routinely close the mesentery after colorectal resection. Nevertheless, especially after the introduction of operations such as right colectomy with complete mesocolic excision and ileocolic resections with extensive mesentery removal for Crohn's disease, the wide mesenteric defect resulting from the dissections can certainly expose the patients to complications such as internal hernias or volvuli. In general, mesenteric closure requires intracorporeal suturing. We describe a simple technique for the closure of the mesentery after surgical resection using polymer-ligating clips. This novel technique seems to minimize the time, effort and risk inherent to the procedure, even after large mesenteric excisions.

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“…et al [ 14 ] 1 58 Male Early gastric cancer Laparoscopy-assisted distal gastrectomy with Billroth I gastroduodenostomy 6 months Anastomosis site Disappeared Spontaneously 2018 Korea Kordzadeh A. et al [ 15 ] 1 69 Female Squamous cell carcinoma of the distal oesophagus Minimally invasive oesophagectomy with intrathoracic hand-sewn oesophago-gastric anastomosis 3 months Gastric conduit Gastroscopy and removed 2018 United Kingdom Rou WS. et al [ 16 ] 1 53 Female Cholecystolithiasis Laparoscopic cholecystectomy 10 months Comon bile duct ERCP, endoscopic sphincterotomy and removed with a stone-retrieving basket 2018 Korea Barabino M. et al [ 17 ] 1 65 Male Cholecystolithiasis Laparoscopic cholecystectomy 3 months Comon bile duct Roux-en-Y choledochojejunostomy 2018 Italy Pang L. et al [ 18 ] 6 31 Female Cholecystolithiasis and choledocholithiasis Laparoscopic cholecystectomy and common bile duct exploration 4 months Comon bile duct Fiberoptic choledochoscop...…”

Section: Discussionmentioning

confidence: 99%

Migration of non-absorbable polymer clips in hepato-biliary-pancreatic surgery: a report of four cases

et al. 2021

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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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Hem-o-Lok clip migration into the duodenum after laparoscopic digestive surgery: a systematic review

Cited by 9 publications

References 29 publications

Hem-o-Lok polymer clips for major vascular control in paediatric minimally invasive surgery

Hem-o-Lok polymer clips for major vascular control in paediatric minimally invasive surgery

Mesenteric closure with polymer-ligating clips after right colectomy with complete mesocolic excision for cancer and mesentery-based ileocolic resection for Crohn’s disease

Migration of non-absorbable polymer clips in hepato-biliary-pancreatic surgery: a report of four cases

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