Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
the transfer time is likely to be long, insert a urinary catheter, wrap
the penis in sterile gauze, and tape the gauze in place. During the
transfer, the client should lie flat. At all times, the client and his
relatives should be kept informed about what has happened and
what is going to be done. The risk of such accidents is reduced if
the surgeon has received proper training and certification, and if
there is a system of ongoing appraisal and recertification. Risks
are higher if the surgeon becomes overconfident, or when
timetable constraints result in operations being done in a hurry. To
avoid this, countries need to have established and well-funded
training and recertification procedures, and clinics need to ensure
that adequate time is allowed for surgery.
• Severing of the glans. If part or all of the glans has been
severed, it should be wrapped in a sterile paraffin gauze to prevent
drying and placed in a polyethylene bag. The man and his glans
should be transferred as soon as possible to a referral centre,
where it may be possible to reattach the glans.
Complications occurring within the first 48 hours after surgery
• Bleeding is the most likely complication during the first 24–48
hours. A small amount of bleeding onto the gauze dressings is
usual, but may alarm the client. If he comes back to the clinic with
blood-soaked dressings, these should be removed and the
circumcision wound inspected for an obvious bleeding point. If
there is fresh blood from the skin edge, a further suture should be
inserted. This will require a full sterile procedure, as for the original
circumcision, including local anaesthesia and sterile draping.
Usually, placing one or two additional mattress sutures over the
area will stop the bleeding.
• Haematoma may form and may be associated with considerable
bruising and skin discoloration. In general, haematomas are best
left alone, unless they are very large or there is continued
bleeding. The choice is between applying a further clean dressing
and reviewing the situation in 24 hours, or applying a clean
dressing and sending the client to a referral centre. If the
circumcision team is relatively inexperienced, it is safer to send the
man to the referral centre.
• Wound disruption is unusual in the first few days, but is
sometimes seen in association with subcutaneous bleeding and
haematoma formation, when the stitches cut out. In this situation
the man should be sent to a referral centre. The specialist at the
referral centre may decide either to suture the wound or to leave it
to heal by secondary intention, depending on the state of the skin
edges. If the disruption occurs within 48 hours of the operation, it
is usually better for the clinic surgeon to explore and re-suture the
wound.
Postoperative care and management of complications Chapter 7-7