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Review
. 2020 Jan-Mar;24(1):e2019.00053.
doi: 10.4293/JSLS.2019.00053.

Clip as Nidus for Choledocholithiasis after Cholecystectomy-Literature Review

Daniel Yee Lee Ng  1 , Wilson Petrushnko  1 , Michael Denis Kelly  1
Affiliations
Review

Clip as Nidus for Choledocholithiasis after Cholecystectomy-Literature Review

Daniel Yee Lee Ng et al. JSLS. 2020 Jan-Mar.

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.

Keywords: absorbable clips; biliary surgery; clip migration; electrosurgical vessel-sealing devices; harmonic scalpel; laparoscopic cholecystectomy; ligasure; surgical clip; ultrasonic coagulating shears.

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Conflict of interest statement

Conflicts of Interest: The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Obstructive jaundice in a 70-year-old man, 12 years after laparoscopic cholecystectomy. ERCP cholangiogram clearly shows the presence of a metallic clip in the stone (arrow).
Figure 2.
Figure 2.
A 68-year-old man presented with cholangitis having had open cholecystectomy 35 years before. Computed tomography showed a metallic clip in the bile duct with proximal dilatation (Toshiba Aquilion Prime 160 slice).
Figure 3.
Figure 3.
Endoscopic view of the same patient after endoscopic sphincterotomy and balloon trawl removal of the stone with the clip just visible within the stone.
Figure 4.
Figure 4.
ERCP cholangiogram of the same patient showing a bile duct stone formed on a metallic clip.
See this image and copyright information in PMC

References

    1. Xia Y, Gao XF, Shi CY, Jiang YH, Yi X. Migration of hem-o-lock clips and stitches into the duodenum after laparoscopic hepatectomy and cholecystectomy: a case report. Medicine (Baltimore). 2019;98:e18153. - PMC - PubMed
    1. Kou K, Liu X, Hu Y, Luo F, Sun D, Wang G, et al. Hem-o-lok clip found in the common bile duct 3 years after laparoscopic cholecystectomy and surgical exploration. J Int Med Res. 2019;47:1052–1058. - PMC - PubMed
    1. Peters X, Bhargava G, Gangemi A. A case report of choledocholithiasis 33 years after cholecystectomy. Int J Surg Case Rep. 2017;41:80–82. - PMC - PubMed
    1. Rasool S, Yahya KM, Rehan AG. Retrieval of surgical clip from common bile duct by endoscopic retrograde cholangiopancreatography: a rare complication of laparoscopic cholecystectomy. J Pioneer Med Sci. 2017;7:21–23.
    1. Taketomi HT. Acute cholangitis caused by migration of metal clips as a nidus for the formation of common bile duct stones 13 years after undergoing laparoscopic cholecystectomy. Eur Surg Res. 2017;58(Suppl 2):35.

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