A Systematic Review of Post-surgical Adverse Events Related to Hem-O-Lok Clips: A Commonly Used Device With Potential Complications

Since their introduction, Hem-o-lok clips (HOLCs) have become widely accepted and increasingly reliable devices among surgeons performing minimally invasive surgery due to their effectiveness in achieving vascular pedicle control and haemostasis. Although HOLCs are generally regarded as safe devices, various complications have been reported. This review aimed to identify and summarise complications occurring at any time following HOLC use, from their initial introduction in January 1999 through December 2025. This literature review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search of PubMed (MEDLINE®), Google Scholar™, ResearchGate, and Embase® was performed using predefined search strings and Boolean operators to identify English-language articles reporting complications associated with HOLC use. The most frequently reported postoperative complications associated with HOLCs occurred after prostatectomy, accounting for 66.23% (n = 51) of all reported cases. The second most common postoperative complication was associated with laparoscopic cholecystectomy, representing 14.28% (n = 11) of cases. The most common complication was clip migration to the urinary bladder with stone formation, accounting for 45.45% (n = 35), followed by urinary bladder neck contracture (14.29%; n = 11), clip migration to the ureter and erosion into the collecting system (14.29%; n = 11), erosion into the duodenum/resulting in duodenal ulcer formation (10.39%; n = 8), and common bile duct (CBD) obstruction (including Mirizzi syndrome or CBD stones) (3.89%; n = 3). Other less frequently reported complications, comprising 11.69% (n = 9), included clip migration to the urinary bladder without stone formation, clip migration to the rectum, erosion into the small intestine, transmural migration to the oesophagus, and anastomotic leak following prostatectomy. Although HOLCs are generally considered safe devices, rare but clinically significant complications have been reported. A high index of clinical suspicion is essential for the early recognition and diagnosis of these complications. The management of HOLC-related complications varies according to the site and nature of the complication but most commonly involves endoscopic retrieval. Conservative management may be appropriate in selected asymptomatic patients.