Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) Haemostasis a Minimizing blood loss is part of good surgical technique and safe medical practice. It is very important, particularly for men who are anaemic. (Ideally, these men should not be circumcised in the clinic, but should be referred to a hospital.) Another important reason to minimize blood loss is to reduce contamination of instruments, operating theatre drapes and gowns, to lower the risk of transmitting blood-borne diseases, such as HIV and hepatitis B, to theatre staff. The following techniques can be used to reduce blood loss. Compression. After the incision has been made, and at any time during the procedure, oozing of blood from cut surfaces can be controlled by applying pressure over a gauze swab for a few minutes. Usually, this will stop the bleeding. Temporary occlusion of blood vessels. Control individual bleeding vessels by applying an artery forceps to the blood vessel (Fig 5.1), grasping a minimal amount of adjacent tissue. Fig 5.1 Artery forceps applied to occlude a blood vessel An alternative technique is to pick up the vessel using forceps (tweezers) and then apply an artery forceps (Fig 5.2). a Adapted from World Health Organization Surgical care at the district hospital. Geneva, World Health Organization, 2003 Surgical procedures for adults and adolescents Chapter 5-2
Male circumcision under local anaesthesia Version 3.1 (Dec09) A B Fig 5.2 Picking up a blood vessel with forceps (tweezers) (A) to facilitate accurate placing of the artery forceps (B) Tying and under-running. Either tie the vessel or under-run and tie it. The simplest procedure is to tie the vessel below the artery forceps (Fig. 5.3). The basic tie consists of two throws (Fig. 5.3A), but many surgeons make a third throw (Fig. 5.3B) to give the knot extra security. A B C Fig. 5.3 Simple tie. A: the knot with two throws. B: the knot with three throws. C: the finished knot pulled tight. It is important to ensure that the tie is securely placed and not liable to slip off, particularly in the first few days following the operation during a penile erection. If there is any doubt about the security of the tie, it is better to use the under-running technique (Fig. 5.4). Secure the bleeding vessel with an artery forceps. Pass the suture needle just beneath the artery (not too deep!) and pull through, leaving enough suture material for the tie. Then pass the suture beneath the vessel a second time, pull gently to occlude it, and tie a knot, as above. . Surgical procedures for adults and adolescents Chapter 5-3
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Manual for Male Circumcision under Local Anaesthesia

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