Manual for Male Circumcision under Local Anaesthesia

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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 (
Male circumcision under local anaesthesia Version 3.1 (Dec09) Dorsal slit method for children The dorsal slit technique can be undertaken by any skilled surgeon, using standard operating instruments. The technique is useful in clinics undertaking limited numbers of paediatric circumcisions. The penis of an infant is small, and any surgeon who is going to undertake paediatric circumcision should already be competent with general surgical skills and adult procedures. There is a need for fine movements and small tissue bites. In particular, the surgeon must take care in the region of the frenulum, because the urethra is close to the skin, and can easily be injured. Step 1. After cleaning, draping, and anaesthesia, a sterile marking pen or gentian violet is used to mark the line of the circumcision over the corona, with no tension on the foreskin, using the technique described in Chapter 5. e Fig. 6.4 Marking the line of the circumcision. Step 2. Clamp the foreskin at the 12 o’clock position, taking care not to place the tip of the clamp beyond the previously marked circumcision line (Fig. 6.5). Close the clamp to crush the skin and leave in place for one minute. This reduces bleeding. e Kaplan GW. Complications of circumcision. Urol Clin North Am 1983; 10543-549 Infant and paediatric circumcision Chapter 6 - 9
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Male circumcision under local anaes
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Manual for Male Circumcision under Local Anaesthesia

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