Biliary complications secondary to post-cholecystectomy clip migration: a review of 69 cases.
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
Chong
Vui Heng
VH
Endoscopy Unit, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710 Brunei Darussalam. chongvuih@yahoo.co.uk
Chong
Chee Fui
CF
D002763:Cholecystectomy / Q000009:adverse effects* / Q000295:instrumentation*; D042883:Choledocholithiasis / Q000209:etiology*; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D012008:Recurrence; D013525:Surgical Instruments / Q000009:adverse effects*; D013997:Time Factors