A prospective randomized controlled trial measuring satisfaction and parents stress after Gomco and Plastibell infant circumcision.

PURPOSE: To compare the physician and parental satisfactions between the two types of circumcision maneuvers used in our units, Gomco and Plastibell circumcision. METHODOLOGY: This study was performed from 2019 to 2021. A total of 190 children were circumcised either by Gomco or Plastibell procedure. Each child was evaluated during the procedure, immediately after the operation, and 1, 2, and 3 weeks after the procedure. Data were collected, statistically analyzed using SPSS version 25. RESULTS: A total of 190 children underwent circumcision from 2019 to 2021. Of the total 190, 98 children (51.6%) underwent circumcision by Gomco, while 92 (48.4%) underwent circumcision by Plastibell. Bleeding was significantly higher in Plastibell method, while excess skin was significantly higher in Gomco method (p value 0.048). Physician evaluation results show no significant difference between both methods in late physician evaluation. 23/92 (28%) of parents were not satisfied after Plastibell circumcision, compared to 8/98 (8.2%) of parents who were not satisfied with the results of Gomco circumcision (p value 0.002). CONCLUSION: Gomco needs a longer operative time, and Plastibell circumcision is less preferable by parents. There is no significant difference in physician satisfaction between the two procedures, but parents are less satisfied with Plastibell circumcision.

Outcome assessment of office Plastibell circumcision in infants utilizing interactive electronic health record.

OBJECTIVE: To assess the outcomes of office-based circumcision performed using Plastibell devices in infants, utilizing the MyChart interactive electronic health record (iEHR) system to monitor the progress and identify potential complications. METHODS: This is a prospective cohort study conducted between March 2021 to April 2022 on all infants undergoing office based Plastibell circumcision. Parents were encouraged to submit concerns via MyChart and to submit photos if the ring has not fallen by post-procedure day 7. Telehealth or in-person clinic visits were then made accordingly. Postoperative complications were collected and compared with existing literature. RESULTS: Of the 234 consecutive infants, the average age was 33 days (9-126 days) and the average weight was 4.35 kg (2.5-7.25 kg). A total of 170 parents (73%) responded to MyChart messages. Fourteen (6%) complications necessitating local intervention were identified: excessive fussiness (1), bleeding (2), ring retention (11) including 2 incomplete skin division requiring repeat dorsal block and surgical completion, fibrinous adhesion (3), and proximal ring migration (6). The photo and messages submitted through iEHR facilitated early patient return for intervention. Additionally, 17 parents submitted photos which were expected postprocedural findings and were reassured through iEHR, thus omitting unnecessary return visits. The 2 patients with incomplete skin division occurred early in the series using the included cotton ties. Subsequent procedures were performed with double 0-Silk ties (n = 218) without similar finding. CONCLUSION: The interactive utilization of iEHR communication in the post-circumcision period identified proximal bell migration and bell trapping, allowed earlier intervention and reduced complications. LEVEL OF EVIDENCE: Level 1.

Anthropometric Predictors of Appropriate-Sized Plastibell for Neonatal Circumcision.

Background: Using anthropometric parameters to determine the appropriate Plastibell size before circumcision ensures that cumbersome carrying of all the sizes before each procedure is eliminated and also complications reduced. Methods: Male neonates who presented for routine circumcision by Plastibell method were recruited. Collected on a proforma were their age in days, weight in Kg, stretched penile length (SPL) in cm, penile diameter (PD) in cm and the Plastibell size used by the "circumciser". The routine circumcision was carried out for each neonate according to protocol. P value was set at <0.05. Results: There were 231 neonates who had Plastibell circumcision. Their mean age, weight, SPL and PD were 15.6(±5.73) days, 3.7(±0.58) Kg, 3.66 (±0.58) cm and 3.79 (±0.64) cm, respectively. Plastibell size 1.3 is the most used (53.6%). There was a positive correlation between weight, SPL, PD, on one hand and Plastibell size , on the other hand with P-values of <0.001, <0.001 and <0.001 respectively. The weight was a weak determinant for Plastibell sizes 1.1 and 1.3: (OR 7.104; 95% CI 1.108 - 45.559; P = .039) and (OR 2.044; 95% CI 1.054 - 3.963; P = .034) respectively. The SPL is also a weak predictor for Plastibell sizes 1.2 and 1.5: (OR 2.176; 95% CI 1.136 -4.136; P = .019) and (OR .043; 95% CI .072 - .984; P = .047), respectively. Conclusion: The anthropometric parameters correlate well with Plastibell sizes. However, they are not effective in predicting the appropriate sized Plastibell for neonatal circumcision.

Circumcision With the Plastibell Technique: A Descriptive Case Series.

Background The Plastibell technique is one of the most commonly performed procedures used for male circumcision (MC) and is in practice throughout the world. It is a procedure done under local anaesthesia, mostly on infants. The results of the technique have been evaluated in many studies throughout the world. We have done a series of cases and present the results of our retrospective descriptive study. The objective of this study was to describe the outcomes of circumcision performed via the Plastibell technique. Materials and methods This retrospective descriptive study was conducted at the Surgical A Unit, Khyber Teaching Hospital, Peshawar from July 2013 to June 2021. Clinical records of the infants who underwent circumcision were collected. Infants under the age of six months brought by their parents were included in the study. Infants whose parents requested methods other than Plastibell and infants with bleeding disorders or a family history of such disorders were excluded from the study. The indication for circumcision was for religious reasons in all cases. Post-operative complications were noted in all cases. Results A total of 364 male babies under the age of six months (mean age 43.5±15 days) underwent circumcision with the Plastibell technique. The mean operative time was 11.3±3.7 minutes. The time it took for the ring to fall off was 7.8±3.04 days. In one case, primary haemorrhage required exploration and diathermy of the bleeder. Oedema occurred in 76(20.8%) of the babies. Adhesions of the foreskin with the glans were formed in 3(0.82%) cases. Conclusion Male circumcision is one of the oldest surgical procedures performed. Several methods are in practise in this regard. The results of our study showed that circumcision with the Plastibell method is safe and has fewer side effects.

Comparison of ring instruments and classic circumcision methods: a systematic review and meta-analysis.

Aim: To determine the advantages and disadvantages of both methods by comparing classic circumcision methods with circumcision methods assisted by ring instruments. Material-Methods: Only studies that compared open procedures and ring devices for male circumcision were included. A total of 6226 patients were examined in 14 studies. The methodological quality of RCT was evaluated using Cochrane collaboration's tools. The Review Manager software statistical package was used to analyze the ORs for dichotomous variables and the mean differences for continuous variables. The proportion of heterogeneity across the studies was tested using the I 2 index. Potential publication bias was assessed by identifying the presence of visual asymmetry/symmetry with funnel plot studies. Results: There were 1812 patients in the open circumcision group and 4414 patients in the ring groups. In total, there was no difference identified between the groups. The open procedure had an advantage compared to the Plastibell subgroup for hemorrhage, while in the other two subgroups, the ring instrument groups had the advantage. Statistically significant in favor of ring devices was found in operating time.There was no difference between the groups for early (postoperative) pain scores. For late-period pain scores, differences with statistical significance were identified in favor of ring devices both in subgroups and in total. For satisfaction, apart from one study in the PrePex group, statistical significance was obtained in favor of ring devices for the other subgroups and in total. Conclusion: The main factors in favor of the use of ring instruments for circumcision are the short total surgical duration, not requiring advanced surgical experience, ease of learning and application, and patient relative satisfaction rates. However, it is a condition to know open circumcision methods and to have experience of this surgery for use in situations with hemorrhage complications, mainly, and without ring instruments of appropriate size.

The effect of inpatient versus outpatient location on postoperative healthcare utilization after neonatal circumcision.

BACKGROUND/PURPOSE: Neonatal circumcision is a common pediatric procedure performed in both the inpatient and outpatient setting. We aimed to determine if procedure location affected 30-day post-procedure healthcare utilization rates, inpatient length of stay (LOS), and amount charged. METHODS: We performed a retrospective cohort study comparing 30-day postoperative healthcare utilization (emergency department (ED) visits, office visits, readmissions) of full-term infants who underwent an outpatient versus inpatient (same admission as birth) circumcision from 2015 to 2020. Statistical analyses included Chi-square tests, multivariable adjusted logistic regression models when appropriate. RESULTS: 3137 infants were included, 1426 (45.5%) had an outpatient circumcision, 1711 (54.5%) an inpatient. Outpatient had similar overall healthcare utilization rates as inpatients (5.7% vs. 5.6%, p = 0.933). The number of ED visits (1.5% vs 0.8%, p = 0.055), office visits (4.5% vs. 5.1%, p = 0.437), and readmissions (0.2% vs. 0.0%, p = 0.058) were not significantly different. Infants with inpatient circumcisions had longer LOS after adjusting for age, ethnicity and delivery type (Cesarean versus vaginal) with an incident rate ratio of 1.97 (95% confidence interval 1.84-2.11, p<0.001). Outpatient circumcision resulted in average charges of $372 more than inpatient. CONCLUSIONS: Outpatient circumcision has a minimal effect on healthcare utilization rates but lead to a shorter hospital stay following birth and increased charge. STUDY DESIGN: Retrospective LEVEL OF EVIDENCE: III.

Neonatal Circumcision.

Neonatal circumcision is one of the most common elective surgical procedures in the United States and globally. This procedure, to remove part of the penile prepuce or foreskin, is done for a variety of personal, social, and medical reasons. There are several proposed benefits, risks, and ethical considerations to discuss with parents before the procedure. Three equally safe and effective methods are used for circumcision, and each uses unique equipment: the Gomco clamp, the Mogen clamp, and the Plastibell device. Choice of technique should be guided by operator training and comfort.

A controlled trial of Gomco versus Plastibell for neonatal circumcisions in Saudi Arabia.

BACKGROUND: Gomco or Plastibell devices are the most widely used method for circumcision. The present work was aimed to assess the incidence of complications in infants of ages up to six months in two used methods. METHODS: It was a prospective randomized study conducted at a pediatric surgery clinic in 3 hospitals in Jeddah, Saudi Arabia. Eight hundred and five children, their ages were less than 6 months were enrolled for the present work. Children were randomized into two groups: Groups P and G using Plastibell and Gomco Circumcision methods, respectively. Statistical analysis of data was performed by using SPSS Version 17. Chi-square test and independent sample t-test was applied to compare both qualitative and quantitative variables, respectively. P-value was considered as significant difference at <0.05. RESULTS: Seven hundred eighty three children were were enrolled in this investigation. Plastibell method was concomitant with low volume of bleeding in comparison with Gomco method (P  < 0.001). Incidence of complications including infection, penile edema, proximal migration and redundant skin was higher in Plastibell device method (P<0.05). CONCLUSION: Gomco circumcision is the safer method and is accompanied with lowest rate of complication.

The study of the factors affecting the time of ring fall off in circumcision using Plastibell.

INTRODUCTION: Circumcision is one of the oldest surgeries and is commonly done in various communities. One of the most common methods of this operation is using a ring or plastible. Given that one of the complications of circumcision by the ring is a delay in the ring fall off, this study is done with the purpose of determining the factors that affect the time of the ring fall off. MATERIALS AND METHODS: This study was done in case series-prospective way. At first, local anesthesia was performed in the form of ring block and using 0.2 cc lidocaine 2% per kg body weight with an insulin syringe and then, by making a linear incision on the foreskin, a ring of the right size was placed on the glans. The foreskin was stretched on the ring and the 0-2 or 0-3 suture was tied to the ring groove and finally, the foreskin was removed from the distal part to the ring. Parents were asked about age, size of suture used, time of ring fall off, and status of sitz bath usage and were recorded even they done completely, incompletely, or not. RESULTS: Finally 465 patients started the study with the average age of 7.55 4 ± 4.72 months. The average time of the ring fall off was 66.7 ± 60.2 days. People who had used the sitz bath completely (92.6 ± 36.2 days), compared to those who had used incompletely (63.8 ± 06.2 days) or no use at all (93.9 ± 58.2 days), they had shorter ring retention time (P < 0.001). Also, people who were used 0-3 suture had shorter ring retention time compared to those who were used 0-2 suture (82.6 ± 42.2 days versus 56.2 ± 27.8 days and P < 0.001). There was a significant relationship between age of ring retention and age, and the time of the ring fall off is shorter in those who are younger and the "less than or equal to 3 months" age group had the least time of the ring fall off. CONCLUSION: The results of this study showed that there is a significant relationship between the duration of the ring fall off and the age of individuals and the use of a sitz bath and the use of thinner suture (0-3).

Plastibell circumcision: Comparison between neonates and infants.

BACKGROUND: The Plastibell circumcision technique has gained popularity worldwide. It has a low bleeding risk which makes it suitable for a vulnerable population and in late circumcision. However, several problems resulting from prolonged retention of the Plastibell ring were reported. OBJECTIVES: The objectives of this study were to assess the outcomes of circumcision performed using Plastibell devices, report ring-related complications, and compare the complications of the technique between neonates and infants. METHODS: This was a retrospective cohort study that was conducted in a total of 989 male neonates and infants who had Plastibell circumcision performed by a single surgeon between June 2006 and February 2018. Postoperative complications were reported and compared between the two age groups. The indications of the Plastibell technique were religious in 988 patients and urinary tract infection in 1 patient. RESULTS: During the study period, Plastibell circumcision was performed in 633 neonates and 356 infants. The average ages of neonates and infants were 14 ± 2 days and 3 ± 0.5 months, respectively. Complications developed in 89 cases, 4.4% in neonates and 17% in infants (P < 0.001). The retained ring was the most common complication in 46 cases (4.6%), followed by excess skin in 21 cases (2%). Bleeding occurred in 10 cases (1%), infection in 7 cases (0.7%), and hematoma in 2 cases (0.2%). CONCLUSION: Complications of Plastibell circumcision are significantly higher in infants than in neonates, and ring retention is the most common complication in both the groups. However, the risk of severe hemorrhage is low making it a good option for infants in the outpatient setting.

Neonatal plastibell circumcision: does the thread type matter? a prospective randomized study.

INTRODUCTION: Plastibell is one of the most common disposable devices used for circumcision. The study aims to determine whether changing the thread type from cotton to polypropylene to tie around the Plastibell in neonatal circumcision would result in faster separation of the ring. PATIENTS AND METHODS: Prospective, randomized, clinical and biomechanical studies were performed. All circumcisions were performed by a single surgeon. Data collected included anthropometric measures, demographic data, procedure time, complications, parent satisfaction, follow-up, and outcomes. The biomechanical study measured the tensile properties of both threads using a universal testing machine (4465; Instron, Norwood, MA). RESULTS: Two hundred full-term, male neonates aged between 24 and 48 h were circumcised using Plastibell. Both groups were similar in gestational age, age at circumcision, body weight, height, head circumference, Apgar score at 1 and 5 min, procedure time, Plastibell size, and parent satisfaction. The subjects were randomized into two groups of 100 neonates each: group I where Plastibell was tied by a cotton thread supplied by the manufacturer and group II where Plastibell was tied by Polypropylene 0. The mean duration for Plastibell fall-off was 8.98 days and 7.74 days in cotton thread and Polypropylene 0, respectively (P-value < 0.001). There was no difference regarding the complications for both groups. The diameters of the cotton and Polypropylene 0 threads were 0.68 mm and 0.35 mm, respectively. The measured tensile strengths of cotton and Polypropylene thread were 180 MPa and 457 MPa, respectively. CONCLUSION: Plastibell tied by Polypropylene 0 fell off faster than that tied by cotton thread, with no significant differences in adverse effects or complications. This finding might be relevant for anxious parents and caregivers. Further studies are needed to examine other types and sizes of threads to investigate whether this separation period can be reduced further.

Glandular amputation by strangulating tied suture: a case report of late-onset complication in the Plastibell circumcision technique.

BACKGROUND: Circumcision is considered to be a procedure with minimal morbidity but may be associated with catastrophic complications in inexpert hands. CASE PRESENTATION: We presented a 9-year-old boy with a past medical history of circumcision at the age of one year with Plastibell clamp who was referred with severe chronic penile injury due to neglected plastibell string. After string removal under a loupe magnification (4×), we saw a deep circular injury at distal penile shaft which led to painless glandular autoamputation 45 days later. The patient was managed conservatively with daily urethral self-dilation until future reconstructive surgery. CONCLUSION: This complication emphasized the importance of the follow-up visit by a physician for any probable string remnant.

Avoidance of general anesthesia for circumcision in infants under 6 months of age using a modified Plastibell technique.

PURPOSE: There is currently no gold standard for the type of analgesia or preferred circumcision technique in infants requiring circumcision after 1 month of age. Our study presents a modified Plastibell circumcision technique, which offers excellent surgical outcomes, and can be performed under local anesthesia until 6 months of age, thereby avoiding the risks of general anesthesia in delayed circumcision. METHODS: This is a retrospective case series of 508 consecutive male infants between 1 and 6 months of age, from one institution, who all underwent circumcision under local anesthesia, performed by the same pediatric surgeon, from 2013 to 2018. The study parameters included postoperative complications such as re-operation for control of hemorrhage, wound infection, circumcision revision, and urethral meatotomy. RESULTS: There were no re-operations for control of hemorrhage, no wound infections, and no circumcision revisions. One patient developed urethral meatal stenosis requiring urethral meatotomy. CONCLUSION: Our modified Plastibell circumcision technique under local anesthesia is a safe and reproducible alternative for infants between 1 and 6 months of age, whose parents desire circumcision and wish to avoid general anesthesia.

Assessment of meatal stenosis in neonates undergoing circumcision using Plastibell Device with two different techniques.

PURPOSE: It was intended to compare meatal stenosis (MS) as a late complication of neonatal circumcision by using two different methods of Plastibell Device circumcision. MATERIALS AND METHODS: A total of 2,307 healthy term newborns (6-36 hours) who were born between 2007 and 2009 in Niknafs Medical Center of Rafsanjan, Iran, were simply randomized into two groups in a controlled, nonblinded clinical trial. In group A (1,102 neonates), the frenulum was maintained intact without any manipulation, and in group B (1,205 neonates) frenular hemostasis was performed in all cases by thermal cautery. MS was assessed by follow-up visits that were made for all cases at the 24-72 hours, 60th day, 12th month, and 16th month after circumcision. RESULTS: At 2 months follow-up visit, the rate of MS in group A was 4.9% (54) and in group B was 5.9% (71), which was not statistically significant. After 12 months, MS in group A was 8.5% (94) and in group B was 13.7% (165), which was statistically significant (P<0.001). At 16 months after circumcision, in the frenulum intact group, MS was 13.8% (152) and in the cautery group, it was 18.9% (228), which was compatible with significant difference (P=0.001). CONCLUSION: Our experience with large group of cases revealed that neonatal circumcision by using Plastibell Device with intact frenulum technique decreases the rate of delayed MS.

Safety of the plastibell circumcision in neonates, infants, and older children.

OBJECTIVES: The objectives of this study were to determine the safety of the Plastibell device (PD) circumcision in neonates, infants, and older children. PATIENTS AND METHODS: A prospective, descriptive study was conducted in private clinics of district Poonch and district Sudhanuti Azad Kashmir, Pakistan, during the period from November 2014 to August 2017. Research was conducted in light of guidelines set by Helsinki declaration. Healthy male babies free of any clinical signs of illness and congenital anomaly were included in the study. The babies having weight <3 kg at the time of surgery were excluded from the study. The parents/guardian were explained about the procedure and informed consent was taken. The complications that developed postoperatively were recorded. The record of all cases was analyzed retrospectively for safety outcome and complications developed in neonates, infants, and older children. RESULTS: A total of 1000 cases including 655 (65.5%) neonates, 241 (24.1%) infants, and 104 (10.4%) children between 1 and 5 years of age were selected. The PD circumcision was done in all these cases. Of these, 93.5% neonates, 89.6% infants, and 66.3% children older than 1 years of age had no complications postoperatively. The complication rate was highest among the children between 1 and 5 years of age as compared to neonates and infants. The complications such as bleeding prepuce, hematoma, and swelling prepuce were higher in infants than neonates while superficial infection and buried glans were noted more in neonates than infants. CONCLUSION: It may be inferred from our findings that Plastibell circumcision is safer if done in the 1st year of life and younger the age better is prognosis in healthy male babies.

Circumcision in the paediatric patient: A review of indications, technique and complications.

Circumcision is one of the most commonly performed surgical procedures in the world. Despite this, the practice of paediatric circumcision remains highly controversial, and continues to generate ongoing debate. This debate has become more relevant recently with the provisional guidelines from the Centers for Disease Control and Prevention recommending a change of practice. In this review article, we provide an overview of the history and incidence of circumcision, normal preputial development, types of phimosis, the absolute and relative indications for circumcision as well as the evidence base for its use as a preventative measure. Our aim is to provide paediatricians with a greater understanding of this common surgical procedure and the conditions it treats, to guide their clinical practice and parent counselling.

Is the plastibell of any haemostatic value after 24 h?

BACKGROUND: The Plastibell is the most popular circumcision method among mothers in our city. Haemorrhage is its major problem. At our centre, we have recorded many circumcision problems resulting from prolonged retention of the Plastibell ring and this study, therefore, sought to explore the ways of reducing complications resulting from prolonged retention of the ring. PATIENTS AND METHODS: This was a prospective study, in which a total of sixty consecutive male neonates were recruited with all undergoing circumcision using the Plastibell device. Thirty patients were assigned to the subject group, in whom the Plastibell ring was removed by the investigator at 24 h while the other thirty constituted the control group whose Plastibell rings were allowed to fall off on their own. The patients selected were aged between 7 and 28 days. RESULTS: Overall, 4 (6.6%) of the sixty neonatal circumcisions in this study were complicated by haemorrhage. There was minor bleeding in 3 (10%) of the thirty subjects and 1 (3.3%) of the thirty controls. There was no statistically significant difference between the groups (P = 0.3006). One patient each from the subject and control groups bled following slipped ligature a few hours after Plastibell circumcision. The other two patients in the subject group bled following the removal of the Plastibell ring at 24 h. All the bleeding episodes were effectively controlled within 5 min by firm digital pressure only administered through a piece of dry, sterile gauze. CONCLUSION: Post-circumcision haemorrhage was not significantly different between circumcised babies whose Plastibell rings were removed at 24 h and those in whom it was left to fall off on its own.

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

INTRODUCTION: The 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. METHODS: All 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. RESULTS: A 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 1.3 cm (n=1,040, 45.7%) while 1.6 cm 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. CONCLUSION: The 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.

Plastibell Device Circumcision versus Bone Cutter Technique in terms of Operative Outcomes and Parent's Satisfaction.

OBJECTIVE: To compare the rate of complications of Plastibell and bone cutter circumcision technique and recognition of top worries and satisfaction rate in the mind of parents before and after the procedure of Plastibell device (PD) circumcision in infants less than 6 months of age. METHODS: It was a descriptive prospective study conducted at department of surgery Sheikh Zayed Hospital, Rahim Yar Khan. Two hundred parents of infants of less than six months of age were recruited for this study. Infants were divided into two equal groups. Group I included Plastibell circumcision technique and Group II included Bone Cutter Circumcision technique. Data was analyzed using SPSS Version 17. Independent sample t-test and chi-square test was used to compare quantitative and qualitative variables respectively. P-value <0.05 was taken as significant difference. RESULTS: Total number of two hundred infants were included in this study. Most common worries of parents about Plastibell Device circumcision were; fear of fever (42.0%). Fear of pain and bleeding (66.0%). Plastibell Device method was associated with less operation time and bleeding as compared to bone cutter method (P-value <0.0001 and <0.0001 respectively). Incidence of complications other than bleeding and infection was 3.0% in bone cutter method and 1.0% in Plastibell device method. Pain score was significantly less in plastibell device group (p-value <0.0001). Post-operatively, 98% parents showed complete procedural satisfaction in Plastibell group versus 87% parents in bone cutter one month after surgery (P-value 0.003). About 4% parents in bone cutter method group showed cosmetic displeasure versus only 1% parents in plastibell device group. CONCLUSION: The study concluded that Plastibell Device circumcision is a safer technique for circumcision and is associated with highest level of parent's satisfaction.

Plastibell circumcision supported by a calcium-alginate fibre dressing to reduce bleeding.

OBJECTIVE: To assess the benefit of a new technique of a Plastibell circumcision supported by a ventral calcium-alginate fibre dressing, to reduce bleeding from the frenular vessels, the commonest complication of Plastibell circumcision. PATIENTS AND METHODS: This was a retrospective study of 200 neonates circumcised in the Royal Bahrain Hospital over a 2-year period from 2012 to 2014. They had a standard Plastibell circumcision, but a calcium-alginate fibre dressing (Hypo-sorb, Plastod, Italy) was placed over the glans and under the foreskin, to help control bleeding from the frenular vessels. RESULTS: Circumcision using the calcium-alginate fibre dressing reduced the bleeding complication rate to zero. The delayed separation of the bell was 2.9% when using the new technique and 2.5% from our previous data. There were no cases of urinary retention reported, compared to two in the previous results. CONCLUSION: A Plastibell circumcision supported by the calcium-alginate fibre dressing was a safe technique to reduce bleeding.