Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2025; 17(2): 99423
Published online Feb 27, 2025. doi: 10.4240/wjgs.v17.i2.99423
Clip-stone and T clip-sinus post laparoscopic biliary surgery: Two case reports and review of the literature
Ying-Zi Huang, Yuan-Yu Lin, Ju-Ping Xie, Gang Deng, Di Tang
Ying-Zi Huang, Yuan-Yu Lin, Ju-Ping Xie, Gang Deng, Di Tang, Department of General Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, Guangdong Province, China
Co-corresponding authors: Gang Deng and Di Tang.
Author contributions: Huang YZ contributed to the manuscript writing and editing, and literature review; Xie JP and Lin YY contributed to the case information; Deng G and Tang D contributed to the conceptualization and supervision of the study; All authors have read and approved the final manuscript.
Supported by Shenzhen Science and Technology Program Project, No. JCYJ20220530145006013.
Informed consent statement: Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gang Deng, Associate Professor, Department of General Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, No. 628 Zhenyuan Road, Guangming District, Shenzhen 518107, Guangdong Province, China. dengg5@mail.sysu.edu.cn
Received: August 2, 2024
Revised: November 29, 2024
Accepted: December 23, 2024
Published online: February 27, 2025
Processing time: 173 Days and 3.9 Hours
Abstract
BACKGROUND

Laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) are widely used in gallbladder and biliary tract diseases. During these procedures, vessels or tissues are commonly ligated using clips. However, postoperative migration of clips to the common bile duct (CBD) or T-tube sinus tract is an overlooked complication of laparoscopic biliary surgery. Previously, most reported cases of postoperative clip migration involved metal clips, with only a few cases involving Hem-o-lok clips and review of the literature.

CASE SUMMARY

This report describes two cases in which Hem-o-lok clips migrated into the CBD and the T-tube sinus tract following laparoscopic surgery. Case 1 is a 68-year-old female admitted due to abdominal discomfort, and two Hem-o-lok clips were found to have migrated into the CBD 17 months after LC and LCBDE with T-tube drainage, and were removed using a stone extraction balloon. The patient was discharged smoothly after recovery. Case 2 is a 74-year-old male who underwent LC and LCBDE with T-tube drainage and laparoscopic biliary tract basket stone extraction. Nine weeks postoperatively, following T-tube removal, a Hem-o-lok clip was found in the sinus tract, and was extracted from the T-tube sinus tract. The patient recovered smoothly postoperatively. This study also reviews the literature from 2013 to July 2024 on using Hem-o-lok clips in LC and/or LCBDE treatment of gallbladder and biliary diseases and the postoperative migration of these clips into the CBD, T-tube sinus tract, or duodenum.

CONCLUSION

In patients with a history of LC and/or LCBDE, clip migration should be considered as a differential diagnosis.

Keywords: Hem-o-lok; Clip migration; Laparoscopic biliary surgery; Laparoscopic cholecystectomy; Laparoscopic common bile duct exploration; Common bile duct stone; T-tube sinus tract; Case report

Core Tip: Postoperative migration of clips is an overlooked complication of laparoscopic biliary surgery. This report describes two cases in which Hem-o-lok clips migrated into the common bile duct (CBD) and T-tube sinus tract after laparoscopic cholecystectomy (LC) and laparoscopic CBD (LCBDE) exploration operation. One clip was removed using a stone extraction balloon, while the other was expelled spontaneously without treatment. Furthermore, literature regarding clip migration following laparoscopic biliary surgery was reviewed. In patients with a history of LC and LCBDE presenting with biliary colic, cholangitis, or abdominal discomfort, clip migration should be considered a differential diagnosis.