Queen Elizabeth Hospital, London, United Kingdom (all authors).

ABSTRACT

Introduction: Hem-o-lok ligation clips are widely used for the hemostatic control of major mesenteric vessels during laparoscopic colorectal resection. We report 2 rare cases of bowel obstruction and perforation requiring urgent surgical intervention after the application of Hem-o-lok clips (Weck Surgical Instruments, Teleflex Medical, Durham, NC, USA), which were used to occlude vessels and provide hemostasis during elective laparoscopic sigmoid colon resection. In both cases, the clips completely dislodged from the vessels to which they were initially applied and eventually attached to the wall of the small bowel, causing obstruction, ischemia, and perforation.

Case Descriptions: Case 1. An 82-year-old man with Duke’s C adenocarcinoma underwent an elective laparoscopic reversal of Hartmann’s procedure after an elective laparoscopic sigmoid colectomy, which was converted to a Hartmann’s procedure due to an anastomotic leak. The reversal of the Hartmann’s operation was complicated by dense adhesions of small bowel to the inferior mesenteric artery (IMA) remnant, with the Hem-o-lok clips initially used to occlude the artery embedded in the wall of the small bowel and completely dissociated from the IMA. A perforation occurred, associated with the clip-related stricture of the small bowel. Case 2. A 69-year-old woman underwent an urgent laparotomy for a small-bowel obstruction that did not respond to conservative treatment. Her surgical history of perforated diverticular disease included a laparoscopic Hartmann’s procedure that was reversed laparoscopically a few months later. She was found to have a small-bowel obstruction secondary to a Hem-o-lok clip that was completely embedded in the serosa of the bowel wall, with a perforation just proximal to it.

Conclusion: Ligation clips, when properly applied, are regarded as a reliable method of obtaining arterial hemostatic control during laparoscopic colorectal procedures. Migration of the clips, although a rare problem, can cause serious complications that may necessitate further surgical intervention. Previous case reports have shown that Hem-o-lok clips can cause vascular complications. These two cases illustrate that they can cause bowel-related complications that necessitate emergent surgical treatment. It is therefore our view that these clips should not be used for arterial ligation during laparoscopic colorectal surgery.

Key Words: Bowel obstruction, Hem-o-lok clip, Laparoscopic colorectal surgery, Perforation.

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/01/13-00022.pdf”]

The post Hem-o-lok Clip–Related Complications After Colorectal Surgery first appeared on JSLS.

Emory University School of Medicine, Atlanta, GA, USA (Hagopian). Division of Pediatric Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA (Dr. Harmon). Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, GA, USA (Dr. Clifton).

ABSTRACT

Introduction: Newborns with congenital esophageal atresia and a distal tracheoesophageal fistula undergo repair by several different approaches, the newest of which is thoracoscopic. The fistula is frequently occluded using a small polymer or titanium clip at the point of insertion into the trachea.

Case Description: We report the case of a 1-day-old male newborn with proximal esophageal atresia and a distal tracheoesophageal fistula who underwent thoracoscopic repair and who then presented with respiratory distress 10 weeks later. The polymer Hem-o-lok clip (Weck Surgical Instruments [Teleflex Medical], Durham, North Carolina) used to ligate the tracheoesophageal fistula eroded through the membranous trachea, causing partial airway obstruction.

Discussion: This case represents a previously unreported complication of the use of polymer clips in esophageal atresia repair. The possibility of airway obstruction after thoracoscopic repair of esophageal atresia with a tracheoesophageal fistula should raise concern among pediatric surgeons and prompt further study into the use of plastic clips for this type of procedure.

Key Words: Tracheoesophageal fistula repair, Hem-o-lok clip, Thoracoscopic repair, Clip migration

The post Polymer Surgical Clip Migration Into the Trachea of an Infant first appeared on JSLS.

Department of Urology, Room no-331, Maszid Moth Hostel, Ansari Nagar, All India Institute of Medical Sciences, New Delhi, India (all authors).

ABSTRACT

Vesical stone formation over migrated Hem-o-lok clips (Weck Surgical Instruments [Teleflex Medical], Durham, North Carolina) after robot-assisted laparoscopic radical prostatectomy is rare. We report our experience in 2 patients who presented with lower urinary tract symptoms after robot-assisted laparoscopic radical prostatectomy and were found to have vesical stones formed over migrated Hem-o-lok clips.

Key Words: RALRP, Intravesical clip, Hem-o-lok clip.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00233-.pdf”]

The post Intravesical Migration of Hem-o-Lok Clips Presenting as Vesical Calculus After Robot-Assisted Laparoscopic Radical Prostatectomy first appeared on JSLS.