Hair Removal for Groin Surgical Access

Primary Recommendation – Avoid Routine Hair Removal

Routine removal of pubic/groin hair does not decrease surgical‑site infection (SSI) rates and should be avoided unless it is required for adequate visualization of the operative field. American College of Obstetricians and Gynecologists (ACOG) recommendation based on moderate‑quality evidence. [1] [2]
A Cochrane systematic review found no evidence that pre‑operative hair removal prevents infection in groin surgery. Cochrane level‑I evidence. 2
Small comparative studies of perineal shaving versus no hair removal demonstrated no difference in SSI incidence. ACOG moderate‑quality data. 2

If hair must be removed, clipping (not shaving) should be employed to reduce SSI rates. This is a high‑quality recommendation despite the overall evidence being of lower quality. ACOG and The Journal of Urology guidance. [1] [2] 3
Clipping is associated with lower infection rates compared with razor shaving. The Journal of Urology high‑quality evidence. 3

Superior border: from the external inguinal ring laterally to the anterior superior iliac spine. National Comprehensive Cancer Network (NCCN) guideline. [4] [5] 7
Lateral border: a vertical line drawn from the anterior superior iliac spine extending ≈20 cm inferiorly. NCCN guideline. [4] [5] 7
Medial border: a line from the pubic tubercle extending ≈15 cm downward. NCCN guideline. [4] [5] 7
Inferior border: should reach at least the intertrochanteric line of the femur or 1.5–2 cm distal to the saphenofemoral junction. NCCN 2017 update. 9

Choose insertion sites that are not contaminated or potentially contaminated (e.g., burned, infected skin, areas adjacent to tracheostomy or open surgical wounds). American Society of Anesthesiologists (ASA) recommendation. [10] [11]
The inguinal region is regarded as a potentially contaminated site for central venous catheter placement; risk can be mitigated with proper sterile technique and subcutaneous tunneling. ASA guideline. [10] [11]

Do not shave: shaving creates micro‑abrasions that increase SSI risk compared with clipping. ACOG high‑quality evidence. [1] [2] 3
Do not clip unnecessarily: hair removal should be performed only when it truly interferes with the surgical view. ACOG moderate‑quality data. [1] [2]
Do not use an inadequate field preparation: when clipping, the entire surgical field defined by the NCCN borders must be covered to prevent intra‑operative extension of the preparation area. NCCN guideline. [4] [5]