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Journal of Gastrointestinal Surgery

, Volume 14, Issue 4, pp 688–696 | Cite as

Biliary Complications Secondary to Post-Cholecystectomy Clip Migration: A Review of 69 Cases

  • Vui Heng Chong
  • Chee Fui Chong
Original Article

Abstract

Introduction

Post-cholecystectomy clip migration (PCCM) is rare and can lead to complications which include clip-related biliary stones. Most have been reported as case reports. This study reviews cases of clip migration reported in the literatures.

Method

Searches and reviews of the literatures from “PubMed,” “EMBASE,” and “Google Scholar” search engines using the keywords “clip migration” and “bile duct stones” were carried out. Eighty cases from 69 publications were identified but details for only 69 cases were available for the study.

Results

The median age at presentations of PCCM was 60 years old (range, 31 to 88 years; female, 61.8%) and the median time from the initial cholecystectomy to clinical presentations was 26 months (range, 11 days to 20 years). Of primary surgeries, 23.2% was for complicated gallstones disease. The median number of clips placed during surgery was six (range, two to more than ten clips). Common diagnoses at presentations of PCCM were obstructive jaundice (37.7%), cholangitis (27.5%), biliary colic (18.8%), and acute pancreatitis (8.7%). The median number of migrated clip was one (range, one to six). Biliary dilatation and strictures were encountered in 74.1% and 28.6%, respectively. Of the 69 cases of PCCM-associated complications, 53 (77%) were successfully treated with endoscopic retrograde cholangiopancreatography (ERCP), 14 (20.2%) with surgery, and one (1.4%) with successful percutaneous transhepatic cholangiography treatment. One patient had spontaneous clearance of PCCM. There was no reported mortality related to PCCM.

Conclusion

PCCM can occur at any time but typically occur at a median of 2 years after cholecystectomy. Clinical presentations are similar to those with primary or secondary choledocholithiasis. Most can be managed successfully with ERCP.

Keywords

Cholecystectomy Complications Clip migrations Iatrogenic biliary stones Endoscopic retrograde cholangiopancreatography 

Notes

Acknowledgement

We would like to acknowledge the assistance of Chong VS and Lim KC for retrieving some of the identified publications, Chong CM for the figure illustration (Fig. 4), and Ms. Lim Ai Giok for the preparation of the manuscript.

Conflict of Interest

None.

Financial Disclosure

None.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  1. 1.Endoscopy UnitRaja Isteri Pengiran Anak Saleha (RIPAS) HospitalBandar Seri BegawanBrunei Darussalam
  2. 2.Department of SurgeryRaja Isteri Pengiran Anak Saleha (RIPAS) HospitalBandar Seri BegawanBrunei Darussalam

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