Sutureless circumcision - An Indian experience

Tiwari, Punit; Tiwari, Astha; Kumar, Suresh; Patil, Rajkumar V.; Goel, Amit; Sharma, Pramod Kumar; Kundu, Anup Kumar

doi:10.4103/0970-1591.91435

Cited by 15 publications

(19 citation statements)

References 12 publications

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“…Some studies have reported that wound approximation using tissue glue was associated with a shorter operation time, a lower rate of wound infection, and less postoperative pain than wound approximation using sutures [7,9,14]. The reported rate of postoperative bleeding after wound approximation using tissue glue is 2.2-6.7%, which is comparable to the reported rate of postoperative bleeding after wound approximation using sutures [7][8][9][10]15].…”

Section: Discussionsupporting

confidence: 78%

“…Most studies of sutureless circumcision using tissue glue have reported superior cosmetic results compared with standard wound closure using interrupted sutures [7][8][9][10]. Some studies have reported that wound approximation using tissue glue was associated with a shorter operation time, a lower rate of wound infection, and less postoperative pain than wound approximation using sutures [7,9,14].…”

Section: Discussionmentioning

confidence: 96%

“…The indications for circumcision vary from country to country, and include religious and medical reasons [1][2][3]. Various surgical techniques for circumcision have been described, with different results and complications [3][4][5][6][7][8][9][10][11][12]. Many studies have reported that circumcision using a CO 2 laser for cutting and coagulation gives excellent results [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have reported that circumcision using a CO 2 laser for cutting and coagulation gives excellent results [4][5][6]. Tissue glue has also been reported to have advantages over sutures for approximation of the wound edges [7][8][9][10][12][13][14][15][16]. Previous studies have only focused on comparisons between the use of a CO 2 laser and scalpel [4,5], or between tissue glue and sutures [7-10, 12, 13, 15, 16].…”

Section: Introductionmentioning

confidence: 99%

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Combined use of CO2 laser and tissue glue versus conventional surgical techniques for circumcision – A prospective study

Mungnirandr

Wiriyakamolphan

Ruangtrakool

et al. 2015

Photonics &Amp; Lasers in Medicine

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Objective: Use of a CO 2 laser for cutting and coagulation during circumcision has been reported to give excellent results, and tissue glue has been reported to have advantages over sutures for approximation of wound edges. Most previous studies have focused on the comparison between use of a CO 2 laser and scalpel, or between tissue glue and sutures. This study compares results and complications between the combined use of a CO 2 laser and tissue glue, and standard surgical techniques for circumcision. Subjects and methods: Thirty boys were divided into two groups. Group 1 (n = 17) underwent circumcision using a scalpel with approximation of the wound edges using chromic catgut sutures. Group 2 (n = 13) underwent circumcision using a CO 2 laser with approximation of the wound edges using tissue glue. Patient age, indications for surgery, operation time, wound swelling, bleeding, wound infection, local irritation, pain score, and cosmetic appearance were recorded.Results: Group 1 (scalpel+sutures) had a significantly longer operation time (p = 0.011), a higher rate of local irritation (p = 0.016), and poorer cosmetic appearance (p < 0.001) than Group 2 (laser+glue). Bleeding occurred in one patient in Group 1 only. There were no significant differences in pain score, wound infection rate, or the cost of surgery between the two groups (p > 0.05). Conclusions:The combined use of a CO 2 laser and tissue glue has advantages over standard surgical techniques for circumcision, with a significantly shorter operation time, lower rate of local irritation, and better cosmetic appearance. The cost of surgery is similar in both groups.Ziel: Über die hervorragenden Ergebnisse bei der Verwendung des CO 2 -Lasers zum Schneiden und Koagulieren während der Beschneidung wurde bereits berichtet. Ebenso wurde über die Vorteile des Einsatzes von Gewebekleber im Vergleich zu Nähten zur Fixierung der Wundränder berichtet. Die meisten bisher publizierten Studien haben sich auf den Vergleich zwischen der Verwendung eines CO 2 -Lasers und herkömmlicher operativer Techniken mittels Skalpell bzw. zwischen Gewebekleber und Nahtmaterialien konzentriert. Die vorliegende Studie vergleicht die Ergebnisse und Komplikationen zwischen dem kombinierten Einsatz eines CO 2 -Lasers und Gewebekleber mit chirurgischen Standardtechniken zur Beschneidung. Patienten und Methoden: Dreißig Jungen wurden in zwei Gruppen eingeteilt. In Gruppe 1 (n = 17) wurde die Beschneidung mittels Skalpell und Verwendung von Chrom-Catgutnähten durchgeführt; in Gruppe 2 (n = 13) kam der CO 2 -Laser in Kombination mit Histoacryl ® -Gewebekleber zum Einsatz. In beiden Gruppen wurden Brought to you by | New York University Bobst Library Technical Services Authenticated Download Date | 10/10/15 10:52 PM 228 A. Mungnirandr et al.: Combined use of CO 2 laser and tissue glue in circumcision Patientenalter, Indikation für den chirurgischen Eingriff, Operationszeit, Auftreten von Wundschwellungen, Blutungen, Wundinfektion oder lokaler Reizung, SchmerzScore und kosmetisches Erscheinung...

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Combined use of CO2 laser and tissue glue versus conventional surgical techniques for circumcision – A prospective study

Mungnirandr

Wiriyakamolphan

Ruangtrakool

et al. 2015

Photonics &Amp; Lasers in Medicine

View full text Add to dashboard Cite

show abstract

“…[16] However, tissue adhesive closure in general surgery has a somewhat higher wound dehiscence rate compared with sutures. [17] Tiwari et al [18] showed a wound disruption rate of 6.8% (3/44) in boys and men (mean age 31 years) using tissue adhesive, while other case series including both men and boys found a very low rate of wound disruption. [14] However, these case series were small and follow-up rates were not clearly stated.…”

Section: Discussionmentioning

confidence: 99%

Rapid, minimally invasive adult voluntary male circumcision: A randomised trial

et al. 2013

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Background. Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. To facilitate male circumcision scaleup, the World Health Organization is actively seeking circumcision techniques that are quicker, easier, and safer than open surgical methods. Objective.To compare conventional open surgical circumcision with suturing with a minimally invasive technique using the Gomco circumcision clamp plus tissue adhesive. Methods. We conducted a non-blinded randomised controlled trial comprising 200 male volunteers >18 years of age, seen at the outpatient university teaching clinic of the Catholic University of Mozambique. We compared two interventions -open surgical circumcision with suturing v. Gomco instrument plus tissue adhesive. Our primary outcome was intraoperative time and our secondary outcomes included: ease of performance, post-operative pain, adverse events, time to healing, patient satisfaction and cosmetic result. Results. The intraoperative time was less with the Gomco/tissue adhesive technique (mean 12.8 min v. 22.5 min; p<0.001). Adverse events were similar except that wound disruption was greater in the Gomco/tissue adhesive group, with no difference in wound healing at 4 weeks. Levels of satisfaction were high in both groups. The cosmetic result was superior in the Gomco/tissue adhesive group. Conclusions. This study has important implications for the scale-up of VMMC services. Removing the foreskin with the Gomco instrument and sealing the wound with cyanoacrylate tissue adhesive in adults is quicker, is an easier technique to learn, and is potentially safer than open surgical VMMC. A disposable plastic, Gomco-like device should be produced and evaluated for use in resource-limited settings.

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