Manual for Male Circumcision under Local Anaesthesia
Manual for Male Circumcision under Local Anaesthesia Manual for Male Circumcision under Local Anaesthesia
Male circumcision under local anaesthesia Version 3.1 (Dec09) coitus uncomfortable. Instead, close the V-shaped defect by placing the frenular suture 1–2 cm (depending on age and penis size) back from the apex of the V, taking both sides of the defect (Fig. 5.43C). The V incision is thus converted into an inverted T. Suture the rest of the skin as in a normal circumcision (Fig. 5.43D). Fig. 5.43 Variation in technique if the frenulum is tight or scarred Surgical procedures for adults and adolescents Chapter 5-34
Male circumcision under local anaesthesia Version 3.1 (Dec09) Chapter 6 Circumcision of infants and children SUMMARY This chapter gives step-by-step instructions for performing a circumcision on an infant or young child. Four surgical techniques are described: • the dorsal slit method; • the Plastibell method; • the Mogen clamp method; • the Gomco clamp method. Four widely-used surgical techniques for paediatric circumcision are described in this chapter. The recommended techniques are shown in detail so that they can be referred to in the context of a training course. After the initial training, they can be used to reinforce what has been learnt. Surgeons should become expert in the technique most suited to the circumstances of their practice. It is not recommended that a nursing, clinical or medical officer learn all the techniques. It is best to become a master of one. This will produce the best results with the least complications. Circumcision of infants and pre-pubertal boys is simpler than circumcision of older boys and adults, because the penis is relatively underdeveloped and the foreskin less vascular. Healing is quick and complication rates are low. A major disadvantage is that the child cannot give consent for the procedure. In addition, the primary health benefit – reduced risk of HIV infection – is not realized until many years later when he becomes sexually active. Circumcision can be delayed to an older age, when the boy can understand the risks and benefits of circumcision and consent to the procedure himself. Programmes that promote circumcision of young children are likely to have lower morbidity rates and lower cost than programmes targeting adolescents and adults. However, this must be balanced by concerns about consent. SCREENING MALE BABIES AND YOUNG BOYS FOR CIRCUMCISION The screening procedures for infants and young children are similar to those for adolescents and adults, and are aimed at ensuring that the client is suitable for surgery at the clinic. If there is any doubt, surgery should be deferred or the client Infant and paediatric circumcision Chapter 6 - 1
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<strong>Male</strong> circumcision <strong>under</strong> local anaesthesia<br />
Version 3.1 (Dec09)<br />
coitus uncom<strong>for</strong>table. Instead, close the V-shaped defect by placing the frenular suture 1–2<br />
cm (depending on age and penis size) back from the apex of the V, taking both sides of the<br />
defect (Fig. 5.43C). The V incision is thus converted into an inverted T. Suture the rest of the<br />
skin as in a normal circumcision (Fig. 5.43D).<br />
Fig. 5.43 Variation in technique if the frenulum is tight or scarred<br />
Surgical procedures <strong>for</strong> adults and adolescents Chapter 5-34
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