Younas Khan, Muhammad Ayub Khan, Kifayat Khan.
Management of Complicated Circumcision in Children.
Ophthalmol Update Jan ;15(2):141-5.

Objective: Approximately one in three men are circumcised globally, but there are relatively few data on the safety of the procedure. In this study we evaluated cases referred to our pediatric surgical unit with complications of circumcision which may or may not be needed secondary surgical intervention. Materials and Methods: This study was conducted on male neonates, infants and children with complicated circumcision done in the periphery, referred to the department of paediatric surgery MTI LRH Peshawar for proper management from January 2014 to December 2016. 38 complicated circumcision cases were evaluated. The circumcisions were done at various paramedical clinics, home are communal circumcision ceremonies held in villages. Various methods of circumcisions are commonly used in the KPK today. The choice of circumcision method depends on the physician`s level of comfort and training. The time between the complications of circumcision and the admission of the patient to the hospital from the age of one day to 9 years. The most commonly utilized techniques are Qalam blade method, bone cutter, different type clamps applications and open surgical procedures. Each instrument and technique carries its own benefits and complication risks. Results: Circumcision like any surgical procedure does carry the risk of complications, which depends on multiple factors, including anatomic abnormalities, medical comorbidities, surgical techniques and patient`s age. Age range was from one day to 13 years. Death, bleeding, loss of skin/wound dehiscence, trapped/concealed penis, redundant foreskin, preputial adhesions/skin bridges, meatal stenosis, Ureteral injury (UC fistula + hypospadias) and glanular necrosis/glanular amputation were present in 1, 14, 2, 8, 2, 4, 1, 4 and 2 cases respectively. Bleeding was controlled by simple pressure bandage/ligation with chromic or vicryl 4/0 in most of cases. Bleeding due to hemophilia treated accordingly either with fresh blood transfusion /FFP or by factor 8 injection. Trapped on concealed penis was treated by repeated circumcision. Urethral fistulae treated by simple closure. Hypospadias repair was performed with tubular incised plate urethroplasty technique. Glanular necrosis was put on hyperbaric oxygen treatment. Adhesions freeing and revision were performed to all the cases with preputio- glanular fusion. The patient with partial are total glans amputation were admitted to our ward late and since glanular anastomosis was not possible for these patients, a cosmetic improvement was achieved by covering the glans with surrounding tissue. Conclusion: Risk reduction strategies including improved training of providers and provisions of appropriate sterile equipment, are urgently needed.

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