Iftikhar Sadique, Khumair Asif, Khalid Mahmood, Rashid Siraj.
Circumcision by Plastibell - A review of the safety of the technique.
Pak J Med Health Sci Jan ;6(4):966-9.
Objective: To review the results of Plastibell technique for circumcision in outpatient setting. Place: Unit II. Department of Gynecology and Obstetrics. Lady Willingdon Hospital Lahore. Department of Gynecology and Obstetrics, Afif General Hospital, Afif. Saudi Arabia. Department of Gynecology and Obstetrics, Sharif Medical City Hospital Lahore. Design: A descriptive study conducted on out patient basis during the years 1996- 1998, 2000-2002, and 2004-2008 at three different institutions. The data collection was computer based. Subjects and methods: The circumcision was offered to all male babies' ages between one week and two years. Circumcision was carried out using the Plastibell® technique under 1% lignocain ring block/penile block anesthesia. A total of 330 circumcisions were performed and assessed postoperatively after 24 hours and then another visit after the removal of the device at outpatient. Results: Of the 330 babies in 3 babies, all older than 6 months, the separated ring tracked back onto the shaft of the penis and had to be removed using a cutter. Ten babies were referred for incomplete separation of the Plastibell ring; the removal was not required and they detached spontaneously within a few days. Three babies were reviewed for bleeding within 24 hours of the operation. Two of these were seen immediately after circumcision, when the bleeding was seen to be from the torn frenulum. A single 3/0 catgut suture applied to the torn part under the same anesthesia and bleeding was stopped. The other baby found to have loose knot. Another silk noose tied around the previous one and a bleeding stopped. Four babies had referred for suspected wound infection but none was clinically significant. Only one parent showed concern due to late bleeding because of loose knot. Post operative results were excellent with adequate removal of foreskin in all cases. Conclusion: The aim of the study was to provide safe circumcision requested on religious grounds. The technique was simple and easily learned. It is also applicable and safe till 6 months of age. The results are excellent and complications are negligible in this age group. In older babies the complications like overriding of ring are more common. In addition to this the use of local anesthesia in older babies is not sufficient to perform the procedure satisfactorily
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