Hindawi Publishing Corporation Case Reports in Gastrointestinal Medicine Volume 2013, Article ID 251634, 3 pages http://dx.doi.org/10.1155/2013/251634 Case Report Hem-o-Lok Clip in the First Part of Duodenum after Laparoscopic Cholecystectomy Mohammadreza Seyyedmajidi, 1 Seyed Ashkan Hosseini, 1 Shahin Hajiebrahimi, 1 and Jamshid Vafaeimanesh 2 1 Golestan Research Center of Gastroenterology and Hepatology-GRCGH, Golestan University of Medical Sciences, Gorgan, Iran 2 Clinical Research Development Center, Qom University of Medical Sciences, Qom 3719764799, Iran Correspondence should be addressed to Jamshid Vafaeimanesh; j.vafaeemanesh@muq.ac.ir Received 4 March 2013; Accepted 9 April 2013 Academic Editors: G. Bassotti, R. J. L. F. Lofeld, and V. Lorenzo-Z´ u˜ niga Copyright © 2013 Mohammadreza Seyyedmajidi et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Laparoscopic cholecystectomy (LC) and common bile duct exploration (LCBDE) have become the standard surgical procedure for cholecystolithiasis and choledocholithiasis. During the operation, cystic duct and vessels are usually controlled by Hem-o-Lok clips. We report a case with a complaint of severe abdominal pain for the previous 20 days. Her medical history was unremarkable except for laparoscopic cholecystectomy 8 months ago. In upper gastrointestinal endoscopy, two Hem-o-Lok clips at anterior wall of the frst part of duodenum were detected. Terefore, the clip can migrate during postoperative period and Hem-o-Lok is not a very safe ligation method during laparoscopic cholecystectomy. 1. Introduction Tere are several methods for the ligation of structures during minimally invasive operations. Many studies have examined the efcacy and safety of various devices in diferent situa- tions. Each technique has potential drawbacks. Application of end loops requires dexterity and training. Titanium clips can slip from their primary position [1, 2]. New technology has played an important role in the proliferation of laparoscopy. A central issue that remains is meticulous hemostasis, particu- larly for larger vessels [2]. Despite their increasing popularity and widespread use, there has been a paucity of data when objectively comparing the relative safety and efcacy of these devices. Tere are potential disadvantages of energy-based instruments for hemostasis including lateral thermal spread, variable burst pressures, and the generation of smoke, vapor, and particulates which may compromise visibility [3]. Te Hem-o-Lok clip (Weck Closure Systems, Research Triangle Park, NC, USA) was introduced in 1999 (Figure 1). Tis nonabsorbable polymer clip has a lock engagement fea- ture as well as teeth in the jaws that provide good security. In addition, recent experimental studies have tested the ability of the Hem-o-Lok to withstand pressures in comparison with other devices [2, 3]. Tis clip has gained popularity among laparoscopic urologists for the ligation of the renal hilum vessels during minimally invasive nephrectomy. Many others have also adopted the Hem-o-Lok for a variety of laparoscopic procedures in recent years [4]. Laparoscopic cholecystectomy (LC) and common bile duct exploration (LCBDE) have become the standard surgical procedure for cholecystolithiasis and choledocholithiasis. During the operation, cystic duct and vessels are usually controlled by Hem-o-Lok clips [5, 6]. Skeletonization of Calot’s triangle and the controlling of gall bladder vessels and cystic duct successfully are the key points of the LC. Currently, Hem-o-Lok clips are generally used to ligate gall bladder vessels and cystic duct during LC. Besides, it is reported that Hem-o-Lok clips are safe to be used in other operations [7, 8]. In recent years, in few patients who underwent LC and LCBDE, clips were found in common bile duct (CBD) during fberoptic choledochoscope, which is a dangerous fnding.