What is the management for surgical clips in the right groin?

Management of Surgical Clips in the Right Groin

Surgical clips in the right groin should be left in place as they serve as important markers to identify high-risk areas for recurrence, particularly for retroperitoneal or intra-abdominal surgeries, and help guide future radiation therapy if needed. 1

Purpose and Function of Surgical Clips

• Surgical clips are intentionally placed during surgery to mark the periphery of the surgical field and other relevant structures 1
• They help identify high-risk areas for recurrence, especially in cases of microscopically positive or grossly positive margins 1
• Clips serve as guides for potential future radiation therapy, particularly in retroperitoneal or intra-abdominal surgeries 1
• In oncologic surgeries, clips mark the tumor bed to facilitate targeted radiation treatment 1

Management Approach

Observation and Monitoring

• Surgical clips are generally meant to remain in place permanently and do not typically require removal 1
• Regular monitoring through clinical examination is sufficient in most cases 1
• Imaging is only necessary if symptoms develop or if there are concerns about clip migration 1

When to Consider Further Evaluation

• Evaluation should be considered if the patient develops:
  • Pain or discomfort at the clip site 1
  • Signs of infection such as redness, warmth, or drainage 1
  • Palpable mass or abnormality at the clip site 1

Potential Complications to Monitor

• Clip migration is a rare but possible complication that can occur within 1 month to 1 year after placement 2
• Migration risk factors include:
  • Inadvertent clip dislodgment during surgery 2
  • Incorrect placement of clips 2
  • Local suppurative complications 2
• In rare cases, migrated clips can serve as a nidus for stone formation if they enter the biliary tract 2

Special Considerations

For Oncology Patients

• If the patient is undergoing or will undergo radiation therapy, be aware that clips can displace during treatment 3
• The 90th percentile of three-dimensional displacement distance of surgical clips during radiotherapy is approximately 9.8 mm 3
• For patients with significant seroma (≥15 mL), displacement can be more substantial, up to 21.8 mm in three-dimensional distance 3

For Wound Complications

• If wound complications develop in the groin area with exposed clips:
  • Consider vacuum-assisted closure (VAC) therapy for peri-vascular surgical site infections 4
  • Be aware that synthetic vascular graft infections in the groin have a higher risk of developing infection-related complications despite VAC therapy 4
  • Non-healing wounds after VAC therapy are associated with increased risk of amputation and mortality 4

Follow-up Recommendations

• Routine removal of surgical clips is not recommended 1
• If the patient develops symptoms related to the clips, evaluation by a surgeon with expertise in the relevant area is advised 1
• For patients who had oncologic surgery, maintain regular oncologic follow-up as the clips serve as important markers for potential future treatments 1