Can you leave surgical clips in place?

Can You Leave Surgical Clips in Place?

Yes, surgical clips can and should be left in place after polypectomy or other procedures—they are designed to remain permanently in the body and do not require removal. 1, 2, 3

Clips in Gastrointestinal Procedures

Polypectomy Clips Are Permanent Devices

• Hemostatic clips placed during colonoscopy are biocompatible devices intended to remain in the colon permanently. 1, 3
• After successful clip placement for polyp resection sites, particularly for polyps ≥20 mm in the proximal colon, the clips stay in place and gradually become incorporated into the healing tissue. 1, 3
• The American Gastroenterological Association supports prophylactic clipping for large polyps (≥20 mm) in the proximal colon, reducing delayed hemorrhage from 7.2% to 3.7%, and these clips remain permanently. 3

When Clips Are Indicated and Left in Place

• For polyps ≥20 mm in the proximal colon, prophylactic clipping significantly reduces bleeding risk, and clips are left permanently. 1, 3
• For large pedunculated polyps with heads ≥20 mm or stalks ≥5 mm, standard clips or detachable nylon loops (endoloops) can be placed prophylactically and remain in situ. 2, 3
• In patients on anticoagulants with large polyps, hemostatic clips are recommended and left in place to prevent bleeding. 3

Clips for Perforation Closure

• Endoscopic clips used to close iatrogenic colonoscopy perforations <1 cm are left in place permanently with success rates of 59-100%. 1
• Through-the-scope (TTS) clips and over-the-scope clips (OTSC) are both effective for early closure of defects smaller than 2 cm, with overall technical success rates of 93% and clinical success rates of 89%, and these remain permanently. 1
• OTSC clips, made of nitinol, are shaped to include more tissue and can close larger perforations than conventional clips, and they are designed to stay in place. 1

Clips in Other Surgical Contexts

Vasectomy Clips

• Clips applied to both ends of the vas deferens during vasectomy remain permanently in place. 1
• Studies show failure rates of 0.0-0.62% when clips are used on both ends of the vas with or without fascial interposition, and these clips are not removed. 1

Cardiac Surgery Clips

• While the cardiac surgery guideline discusses rigid sternal fixation with plates versus wire cerclage, both methods involve permanent implantation of fixation devices. 1

Important Caveats

Monitoring After Clip Placement

• After endoscopic clip placement for perforation closure, continuous monitoring by a multidisciplinary team including surgeons is essential, even though clips remain in place. 1
• A limitation of endoscopic closure is difficulty evaluating completeness after clip application, which may result in delayed complications like intra-abdominal abscesses despite clips remaining in place. 1

When Clips May Fail

• Detachment of clips from the mitral valve after initial seating can occur in cardiac procedures, but this is a complication of the procedure, not an indication for routine removal. 1
• In colonoscopy, clip detachment from one leaflet can occur if grasping is inadequate, requiring repeat application, but successfully placed clips remain permanently. 1

MRI Considerations

• Most modern endoscopic clips are MRI-compatible, but patients should be screened for foreign bodies before MRI studies. 4

The bottom line: Surgical clips placed during endoscopic or surgical procedures are permanent implants designed to remain in the body indefinitely—removal is neither necessary nor routinely performed. 1, 2, 3