Paediatric Urology Circumcision

Haemorrhage is an important complication of circumcision in children and efforts have been made to try and reduce this. The use of fibrin glue has been advocated and has shown to be helpful even in haemophiliac patients.4,75,76 The use of bipolar diathermy has been successfully used in the paediatric age group for "bloodless circumcisions''.77 Ultrasound dissection scalpels can be used, as they combine gentle tissue dissection with simultaneous haemostasis without the fear of the risks of electrocautery.78 Neonatal circumcisions are often performed with a variety of devices, such as, the Plastibell, the Gomco clamp, and the Mogen clamp.79,80 The Mogen clamp has been reported to cause virtually no blood loss.80 A technique has been described using the Plastibell as a template. The appropriate size of device is chosen and applied to the glans. The foreskin is then pulled back over the bell, and a ligature is tied around the groove. Excess skin is removed with the cutting electrocautery, and the edges are approximated with 5.0 chromic sutures. This technique has shown to be more effective in achieving haemostasis than sleeve circumcision.81

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