Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
PAEDIATRIC SURGICAL METHODS
Four techniques for circumcision of children are described in
this section: the dorsal slit method, the Plastibell method, the
Mogen clamp method, and the Gomco clamp method.
The dorsal slit method with closure of the wound with suture is
not typically used for infant male circumcision and is more
appropriate for older children, particularly in situations where
the surgeon undertakes relatively few procedures so that it is
not practical to stock devices. A small dorsal slit is a
preliminary step when using the Gomco and Plastibell devices.
Typically, in early infancy, the wound does not need to be
closed with sutures, regardless of the device used.
In babies, the foreskin is long in relation to the penis, and there
is little chance of penile erection. This has two important
consequences. First, the glans will be further exposed towards
puberty, as the penis grows relative to the foreskin. Second,
clamping devices that remain on the penis for a few days (e.g.
the Plastibell device) are more feasible than with adults,
because there is less chance of the device being pushed off by
an erection.
In early infancy (< 60 days of age), regardless of which
technique is used, closure of the wound is typically not
necessary. Beyond early infancy (>60 days) better cosmetic
outcomes may be achieved if the wound is closed with simple
interrupted sutures. The Plastibell provides a unique benefit
over the other techniques in that it can be used outside of the
early infant period without regularly requiring surgical closure.
Extremely rare complications such as loss of the glans, urinary
retention and bladder rupture have been reported with the use
of the Plastibell device as a result of migration of the ring onto
the shaft of the penis, which may happen if the wrong size is
used. The Plastibell should only be considered in areas where
follow up is both reliable and easily available.
The Plastibell is a disposable device, whereas the Mogen and
Gomco clamps are reusable. The choice between the different
techniques may depend on the cost of the Plastibell, the need
to sterilize the Mogen and Gomco clamps, the ages at which
circumcision is performed, and the possible need for suturing
skills.
The advantages and disadvantages of the different methods of
paediatric circumcision are summarized in Table 6.2.
Infant and paediatric circumcision Chapter 6 - 7