Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
Table 6.2 Advantages and disadvantages of four methods of paediatric circumcision
Method Advantages Disadvantages Comments
#1
Dorsal slit
Can be performed at any
age in any hospital or
clinic equipped with
standard surgical
instruments.
Requires more surgical skill
than other methods.
Rare risk of urethral injury.
Can be undertaken by
skilled surgeons on an
occasional basis
#2 Plastibell Can be performed outside
of early infancy without
typically requiring closure
of the wound.
Disposable.
Reduced risk of penile
amputation and laceration.
Requires stock of different
sizes of Plastibell.
Routinely requires dorsal slit
with risk of urethral injury.
Rare possibility of injuries
associated with proximal
migration of ring.
May require second clinic
attendance to have bell
removed.
Close follow up and easy
access to care essential.
Suitable for clinics with
large numbers of babies.
#3 Mogen
clamp
Simple, one piece
instrument, only one size,
fastest of all the
techniques, easy to teach
Does not routinely require
a dorsal slit, reducing risk
of urethral injury
Rare risk of partial glans
amputation.
Risk of buried glans if device
applied for too long
In older infants (>60 days)
sutures may be
necessary.
Suitable for clinics with
large numbers of babies.
No parts retained
following the procedure
#4 Gomco
clamp
Reduced risk of penile
amputation.
Routinely requires dorsal slit
with risk of urethral injury
In older infants (>60 days)
sutures may be necessary
No parts retained
following the procedure.
Requires multiple sets and
different sizes of clamps.
Multipart device with risk
that parts will be lost,
damaged or interchanged.
Risk of penile laceration if
device parts interchanged.
Suture material
Sutures are almost always used in the dorsal slit method but
are typically not required for the Gomco and Mogen technique
when used in early infancy (