Circumcision surgical procedure in males involves either a conventional "cut and stitch" surgical procedure or use of a circumcision instrument or device. In the newborn period (less than 2 months of age), almost all circumcisions are done by generalist practitioners using one of three surgical instruments. In the US, the Gomco clamp is the most utilized instrument, followed by the Mogen clamp and the Plastibell.[1] They are also used worldwide.[2]
Complications may include bleeding, infection, reduction in sensation of the glans penis,[3] and too little or too much tissue removal.[4] Deaths are rare.[5][4] After the newborn period, circumcision has a higher risk of complications, especially bleeding and anesthetic complications.[6]
In the 21st century, most circumcisions in boys and men are performed using one of three open surgical methods. The forceps-guided method, the dorsal slit method, and the sleeve resection method are well described by the World Health Organization in their Manual for Male Circumcision under Local Anaesthesia.[7] The Gomco clamp and Mogen clamp are sometimes used after the newborn period, in conjunction with either surgical sutures or cyanoacrylate tissue adhesive to prevent post-operative bleeding.[8]
Circumcision surgical instruments should be distinguished from circumcision devices. Circumcision instruments are used at the time of surgery, and the circumcision is complete at the end of the procedure. The Gomco clamp, the Mogen clamp, and Unicirc are surgical instruments.[9] Circumcision devices remain on the penis for 4 to 7 days and either spontaneously detach or are removed surgically at a subsequent visit.[10] Plastibell, Shang Ring, and other plastic rings are all circumcision devices, also known as "in situ" devices.[9] Circumcision via instrument results in healing by primary intention and healing via devices is by secondary intention, so healing is delayed. All circumcision procedures should involve adequate injectable or topical anesthesia.[6]
^Stang HJ, Snellman LW (June 1998). "Circumcision practice patterns in the United States". Pediatrics. 101 (6): E5. doi:10.1542/peds.101.6.e5. PMID 9606247.
^Manual for early infant male circumcision under local anaesthesia. Geneva: World Health Organization. 2010. Archived from the original on August 12, 2011.
^Williams N, Kapila L (October 1993). "Complications of circumcision". The British Journal of Surgery. 80 (10): 1231–6. doi:10.1002/bjs.1800801005. PMID 8242285. S2CID 27220497.
^ abAmerican Academy of Pediatrics Task Force on Circumcision (September 2012). "Male circumcision". Pediatrics. 130 (3): e756-85. doi:10.1542/peds.2012-1990. PMID 22926175.
^"Manual for male circumcision under local anaesthesia". Geneva: World Health Organization. December 2009. Archived from the original on March 28, 2009.
^Lane V, Vajda P, Subramaniam R (February 2010). "Paediatric sutureless circumcision: a systematic literature review". Pediatric Surgery International. 26 (2): 141–4. doi:10.1007/s00383-009-2475-y. PMID 19707772. S2CID 27495715.
^ abFramework for Clinical Evaluation of Devices for Adult Male Circumcision (PDF) (Report). WHO. 2007. Archived from the original (PDF) on 2011-11-14. Retrieved 2017-04-18.
^Ridzon R, Reed JB, Sgaier SK, Hankins C (June 2016). "VMMC Devices-Introducing a New Innovation to a Public Health Intervention". Journal of Acquired Immune Deficiency Syndromes. 72 (Suppl 1): S1-4. doi:10.1097/QAI.0000000000000967. PMC 4936419. PMID 27331583.
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