Can Internal Surgical Clips Cause Problems? A Comprehensive Guide

September 23, 2025 •

4 min read

While most patients with internal surgical clips never experience complications, rare but serious issues can occur, sometimes years after the initial procedure. This guide provides a comprehensive overview of the potential problems internal surgical clips can cause and what to look for.

Quick Summary

Though typically safe and intended to remain permanently, internal surgical clips can rarely cause problems such as inflammation, allergic reactions to materials like nickel, or migration causing obstruction. Complications are uncommon but can present with various symptoms years after surgery, necessitating medical evaluation.

Key Points

Rare Complications Occur: While generally safe and permanent, surgical clips can rarely cause problems like migration or allergic reactions years after surgery.
Allergic Reactions Are Possible: Some clips, particularly older stainless steel types containing nickel, can trigger a delayed hypersensitivity reaction, causing chronic pain, fatigue, or dermatitis.
Migration Is a Risk: Clips can move from their original placement, potentially lodging in a bile duct and causing obstruction, cholangitis, or pancreatitis.
Symptoms Are Diverse: Watch for persistent abdominal pain, jaundice, fever, unexplained fatigue, or skin rashes long after surgery, as these can indicate a clip-related issue.
Diagnosis is Key: Diagnostic tools like CT scans, MRCP, and ERCP are used to identify clip location and related issues.
Treatment Often Involves Removal: If clips are causing symptoms, they can often be removed via a minimally invasive procedure like ERCP, leading to significant symptom resolution.

What are Internal Surgical Clips and Why are They Used?

Internal surgical clips are small, medical-grade devices used during surgery to clamp and seal blood vessels, ducts, or other tissues. They are an essential tool in many laparoscopic (minimally invasive) procedures, such as gallbladder removal (cholecystectomy), as they allow surgeons to efficiently and securely ligate vessels and tissues without extensive suturing. They are generally made from inert materials, meaning they are designed to be left in the body permanently without causing adverse reactions.

The Purpose and Placement of Surgical Clips

Surgical clips are applied with a specialized device called a clip applier. For instance, in a laparoscopic cholecystectomy, clips are used to secure the cystic duct and cystic artery before the gallbladder is removed. The clips compress the tissue, effectively preventing bleeding and bile leakage. They are considered a fast and reliable method for achieving hemostasis (stopping blood flow) and sealing structures.

Understanding the Materials: What are Surgical Clips Made Of?

The material of a surgical clip is a crucial factor in its performance and biocompatibility. The body's reaction, if any, is often tied to the specific metal or polymer used.

Titanium: This is one of the most common materials due to its high biocompatibility and corrosion resistance. It is radiolucent and non-magnetic, making it safe for MRI scans. However, rare cases of hypersensitivity have been reported.
Stainless Steel: While considered generally safe, some stainless steel alloys contain nickel, which is a known allergen. Patients with a history of nickel allergy may experience a reaction.
Polymers: Some modern clips are made from non-absorbable synthetic polymers. These are useful for patients with metal allergies and are also MRI-compatible.
Absorbable Polymers: For some procedures, absorbable clips are used. They dissolve over time as the body heals, eliminating the foreign body long-term. However, migration is also possible before full absorption.

Potential Problems Caused by Internal Surgical Clips

While a vast majority of patients have no issues with their clips, a small percentage can experience complications. These can manifest shortly after surgery or, in rare cases, many years later.

Clip Migration

One of the most concerning, albeit rare, complications is clip migration, especially following procedures like cholecystectomy. Clips can dislodge from their original position and travel to other areas of the body.

The Pathway of Clip Migration

Erosion: A clip can slowly erode through the tissue, often a bile duct, over time.
Movement: Intra-abdominal pressure and organ movements may contribute to the clip's movement along the path of least resistance.
Lodging: The clip can become lodged in a new location, such as the common bile duct, causing obstruction and inflammation.

Allergic and Inflammatory Reactions

An allergic reaction to the metal in surgical clips, particularly nickel, can occur. This can lead to a type IV hypersensitivity reaction, a delayed-type reaction that can cause chronic, nonspecific symptoms.

Symptoms of a Metal Allergy

Chronic pain, often disproportionate to what is expected post-surgery
Skin rashes, dermatitis, or urticaria
Fatigue and lethargy
Unexplained weight loss or chills
Neuropathy or nerve-related symptoms

Other Potential Complications

Chronic Pain and Inflammation: Even without allergy or migration, the presence of a foreign body can sometimes cause localized inflammation or pain.
Obstruction: A migrated clip can cause blockages in a duct, leading to bile duct stones (choledocholithiasis), pancreatitis, or cholangitis.
Metallosis: This is a rare condition where metallic debris is released from the implant into surrounding tissues, causing a localized reaction.

Diagnosing and Managing Clip-Related Issues

If a patient reports persistent or unusual symptoms after surgery, a healthcare provider will begin with a thorough evaluation. Initial steps often involve diagnostic imaging.

Computed Tomography (CT) Scan: Can visualize the clips and their position, identifying if migration has occurred.
Magnetic Resonance Cholangiopancreatography (MRCP): This specialized MRI can provide detailed images of the biliary and pancreatic ducts to check for obstruction.
Endoscopic Retrograde Cholangiopancreatography (ERCP): A procedure where a flexible endoscope is passed down the throat into the biliary system. It is both diagnostic and therapeutic, allowing for the visualization and removal of migrated clips.
Allergy Testing: If a metal allergy is suspected, specialized tests, such as lymphocyte transformation tests (LTT), may be used to confirm sensitivity.

Comparison of Surgical Clip Materials


Feature	Titanium Clips	Stainless Steel Clips	Absorbable Polymer Clips
Biocompatibility	Excellent; highly inert	Good; potential for nickel allergy	Excellent; designed to dissolve
MRI Compatibility	Fully compatible	Non-magnetic; typically safe	Fully compatible
Long-Term Risk	Very low; rare reactions	Low; small risk of allergy	Very low; dissolves over time
Durability	Permanent; very strong	Permanent; strong	Temporary; dissolves as tissue heals

Treatment for Surgical Clip Complications

Treatment depends on the specific complication. For symptomatic clip migration or obstruction, removal is often the best course of action. This is commonly performed via minimally invasive procedures like ERCP. For confirmed metal allergies, removal of the offending clips may be necessary to resolve the patient's symptoms. In many cases, patients experience significant or complete symptom relief after removal.

When to See a Doctor

It is crucial to seek medical advice if you experience any persistent or new symptoms following surgery where clips were used, even if years have passed. Symptoms to watch for include unexplained abdominal pain, jaundice, fever, fatigue, or chronic skin conditions. Accurate diagnosis and timely treatment are essential for managing any potential issues related to internal surgical clips.

For more detailed information on metal hypersensitivity, you can consult reputable medical research, such as articles from the National Institutes of Health.

Conclusion

While the vast majority of internal surgical clips remain uneventful for patients throughout their lives, a small subset may encounter complications like migration or allergic reactions. Modern medicine has provided alternatives and effective diagnostic and treatment options for these rare occurrences. It is important to remember that such problems are uncommon, but awareness of the potential symptoms and knowing when to consult a healthcare professional is key for ensuring long-term health after surgery.

Frequently Asked Questions

Most internal surgical clips made of metals like titanium are permanent. However, some absorbable polymer clips are designed to dissolve over time as the body heals, though these are not suitable for all surgical needs.

No, surgical clips are typically too small to be detected by airport metal detectors. They are also made of non-ferromagnetic materials like titanium, which are not triggered by these devices.

Symptoms vary but can include persistent or recurring abdominal pain, fever, jaundice (yellowing of the skin), chronic fatigue, or skin rashes. These are often non-specific and require medical investigation.

Diagnosis often starts with a review of symptoms and patient history, followed by imaging studies like a CT scan or MRCP. An ERCP may be performed for a more detailed view and potential treatment.

Yes, clips made of modern biocompatible materials like titanium are safe for MRI scans. They are non-magnetic and will not interfere with the imaging. It is always wise to inform your doctor and MRI technician about your surgical history.

Yes, though rare, an allergy to the metal in the clips is possible, particularly if they contain nickel. This can cause a delayed hypersensitivity reaction, leading to chronic inflammatory symptoms.

Often, yes. If a clip is causing complications like obstruction or confirmed allergic reaction, removal may be the most effective treatment. This can be done via minimally invasive techniques, such as ERCP for migrated clips in the bile duct.