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

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.

Intraoperative Local Ablative Therapies Combined with Surgery for the Treatment of Bilobar Colorectal Liver Metastases.

AIM: To investigate the role of intraoperative local ablation techniques (LATs) in bilobar colorectal liver metastases (bCRLM). PATIENTS AND METHODS: Among patients who underwent LAT for CRLM between 2005 and 2015, we selected 33 patients with bilobar disease submitted to thermal ablation alone or associated to liver resection. Primary end-point was complete local response at one month (CLR). Secondary end-points were morbidity, mortality, disease-free survival (DFS), local tumor recurrence (LTR) and long-term survival. RESULTS: CLR was observed in 100% of cases, while LTR occurred in 8 cases (22%). DFS at 1, 3 and 5 years was 37%, 5% and 5%. Overall survival (OS), in the same interval, was 95%, 49% and 26%. Univariate analysis found a significant correlation between LTR and tumor size (11% ≤20 mm vs. 50% >20 mm; p=0.009). CONCLUSION: LAT is an effective adjuvant strategy in bCRLM for nodules within 20 mm diameter.