Home > Journals > Minerva Surgery > Past Issues > Minerva Chirurgica 2019 December;74(6) > Minerva Chirurgica 2019 December;74(6):496-500



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Minerva Chirurgica 2019 December;74(6):496-500

DOI: 10.23736/S0026-4733.19.08152-5


language: English

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

Matteo BARABINO 1, Carmelo LUIGIANO 2 , Gaetano PICCOLO 1, Rinaldo PELLICANO 3, Micol POLIZZI 1, Marco GIOVENZANA 1, Roberto SANTAMBROGIO 1, Andrea PISANI CERETTI 1, Erika ANDREATTA 1, Maria A. PALAMARA 2, Giuseppa GIACOBBE 4, Pierluigi CONSOLO 4, Enrico OPOCHER 1

1 Unit of Hepato-biliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy; 2 Unit of Digestive Endoscopy, San Paolo Hospital, Milan, Italy; 3 Department of Gastroenterology, Molinette-S. Giovanni Antica Sede Hospital, Turin, Italy; 4 Unit of Digestive Endoscopy, G. Martino Hospital, University of Messina, Messina, Italy

INTRODUCTION: The wide use of hemoclips during laparoscopic surgery has led to a variety of unusual complications, among these, there is the migration of Hem-o-Lok clip into the duodenum. We performed a literature review of all cases of Hem-o-Lok clip migration into the duodenum after laparoscopic digestive surgery reported in literature.
EVIDENCE ACQUISITION: All relevant articles were extracted up to June 2019 based on the results of searches in MEDLINE, PubMed, Scopus, Web of Science and Google Scholar.
EVIDENCE SYNTHESIS: At the time of this review, a total of seven cases have been described. The mean age was 49 years and the majority of these patients were women (57%). Previous laparoscopic surgery was performed for cholecystectomy (four patients), cholecystectomy with common bile duct exploration (one patient), right hemicolectomy (one patient) and distal gastrectomy (one patient). Symptoms occurred from 3 months to 2 years after laparoscopic surgery. The majority of patients developed symptoms of bowel occlusion and abdominal pain. Three patients remained asymptomatic. In many cases the Hem-o-Lok wedged into the wall of the first or second portion of the duodenum. In all cases, esophageal gastroduodenoscopy was the primary modality to make the diagnosis. Initial treatment was conservative with watch-and-wait strategy or proton pump inhibitors followed by endoscopic removal, while surgical treatment was required in two cases.
CONCLUSIONS: The application of Hem-o-Lok clip during laparoscopic surgery is safe and effective. Postoperative Hem-o-Lok migration into the duodenum is rare. The treatment could be conservative in the majority of cases.

KEY WORDS: Foreign-body migration; Digestive system endoscopy; Laparoscopy; Duodenum

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