Plastibell circumcision of 2,276 male infants: a multi-centre study

Abstract

IntroductionThe World Health Organization's manual on male circumcision listed Plastibell technique as a well-proven paediatric method with respect to the results and complications. Although, literatures abound on its wide acceptability, there are few multi-centered reports from this environment. The objective was to evaluate the cases of infant circumcision by Plastibell device from two medical institutions.MethodsAll consecutive infants who had Classical Plastibell Circumcision (PC) at the Federal Staff Medical Centre, Abuja and the Lagos State University Teaching Hospital, Ikeja between February 2011 and June 2015 were included in this cross-sectional study. The procedures were performed by surgical registrars and medical officers after ninety minutes of topical anesthesia to the penis. Data harvested from the standard proforma were analysed using Statistical Package for Social Science 20.0 for window.ResultsA total of 2,276 infants had classical PC within the study period. Their ages at circumcision ranged from 4 days to 3 months with a mean age of 17 days. Majority of the boys were circumcised at second week of life (n=1,394,61.2%). All the cases were performed for religious (53%) and cultural (47%)reasons. The most common Plastibell size deployed was 1.3cm (n=1,040, 45.7%) while 1.6cm was the least commonly used ring (n=10, 0.4%). The mean time for device to fall-off was 6 days (range 4-12 days). There was no correlation between the age at circumcision and Plastibell size. We recorded an overall complication rate of 1.1% with postoperative bleeding leading the pack (n=12, 48%). No case of urethrocutaneous fistula was seen. We detected 17 cases (0.7%) of distal hypospadias in whom circumcisions were postponed till the time of hypospadias repairs.ConclusionThe main indication for infant circumcision in our environment was religious. The PC has good safety profile with few easily correctable early complications. Detailed attention to placement of ligature, selection of appropriate Plastibell size and adequate parental education are key to preventing post-procedure mishaps.

Prepuce health and childhood circumcision: Choices in Canada

“…In their 1981 review, Warner and Strashin noted ranges from as low as 0.06% to a high of 55% reported by Kingston General Hospital. 24,35 This seems to be the trend in the literature; several large series from different parts of the world recorded similar low complication rates: In Israel, Ben Chaim et al report 1.2%; 32 in Nigeria, Biuko et al report 1.1%; 30 and in the U.S., El-Bcheraoul et al report 0.5%. 8 In their study, El-Bcheraoul et al concluded that male circumcision had a low incidence of adverse events overall, especially if the procedure was performed during the first year of life, but rose 10-20-fold when performed after infancy.…”

“…Complication rates are usually minor (0.2-2.0%). 8,[29][30][31][32] Parents are aware of the requirements and rituals in their various ethnic groups and religions are often anxious to secure access for an acceptable facility and date for the circumcision.…”

“…9 Techniques and devices for childhood/neonatal circumcision Details of techniques and devices used for childhood male circumcision are varied and widely available. For neonatal circumcision, devices such as the Gomco ® (Yellen clamp), Plastibell (Hollister Inc. Chicago, IL, U.S.), and the Mogen clamp (29,30) are the three more popular devices available in the U.S. and Canada. 29,34 They are also widely used all over the world.…”

Plastibell circumcision in neonates and infants at tertiary care centre

“…Other studies had documented that the residual plastic ring usually falls off within 10 days of the procedure, while the ring separates faster in neonates due to thin prepuce and easier sloughing. [13][14][15] . The mean surgical time in our study was 4±2 mins which is comparable with other studies.…”

“…The mean surgical time in our study was 4±2 mins which is comparable with other studies. 12,14 The technique of Plastibell circumcision had established itself as an acceptable form of circumcision particularly in neonates to one-year old infants. Complications with this technique were reported to be 2% to 3%.…”