Sutureless circumcision

Sutureless versus interrupted sutures techniques for neonatal circumcision; a randomized clinical trial

INTRODUCTION

and objective: Male circumcision is a common procedure all over the world; in Saudi Arabia, circumcision is the most frequent elective surgical procedure performed on males. The use of sutures for neonatal circumcision may decrease bleeding; however, it may lead to skin sinus formation. The objective of this study was to compare the sutureless to the interrupted sutures technique for neonatal circumcision with Gamco clamp.

PATIENTS AND METHODS

We performed a randomized controlled clinical trial between 2017 and 2018. The study included 182 newborns assigned into two groups. Group 1 (n = 94) included neonates who had sutureless circumcision, and group 2 (n = 89) included neonates who underwent circumcision using interrupted absorbable 6/0 sutures. Study endpoints were bleeding, wound gaping, skin tunneling or sinus, and cyst formation.

RESULTS

There was no significant difference in patients' age and weight between groups. The procedure was significantly longer in group 2 (12.24 ± 2.17 vs. 6.54 ± 1.42 min; p < 0.001). There was no difference in bleeding between both groups (4 (4.26%) vs. 2 (2.27%) in groups 1 and 2, respectively, p = 0.683). Cyst formation was significantly reduced in group 1 (2 (2.13%) vs. 13 (14.77%); p = 0.002) and skin sinus formation increased in group 2 (14 (15.91%) vs. 0 in group 2 and 1, respectively; p < 0.001).

DISCUSSION

Circumcision can be performed with several techniques, and the superiority of one approach over the other is still debated. Many surgeons use interrupted sutures to oppose the skin edges, and in some reports, tissue glue was used for skin edges re-approximation with acceptable cosmetic results. In our study, the mean time taken for sutureless circumcision was about 7 min, and for the suture circumcision, it took around 11 min. In addition, the formation of a skin tunnel or sinuses rate was high despite the use of very thin sutures.

CONCLUSION

Male circumcision is a common and safe technique with minor and treatable complications. Risks of bleeding and sinus track formation are low with the sutureless method. The sutureless technique is recommended after Gamco circumcision as the standard technique for male circumcision in the newborn.

Continuous suturing as a wound closure technique for circumcisions

Male circumcision is an extremely common urological procedure worldwide, with many variations in technique. Despite the large volume there is a low incidence of complications associated with circumcisions, with the majority being Clavien-Dindo I or II. In this study, we analyse the outcomes and complication rates associated with a continuous wound closure following a male circumcision.

Methods:

In a urology department from a single institution, 201 male circumcisions with a continuous wound closure were performed in a 4-year period. Outcomes were analysed retrospectively looking at postoperative complications and readmissions to hospital via our clinical portal.

Results:

No patients had complications that required admission or re-operation at our institution.

Conclusion:

No major post-operative complications were observed from our cohort. There were also no documented admissions back to our institution with wound healing complications. However, a limitation is that Clavien-Dindo I and II complications and treatment at general practitioner surgeries were not captured and may not accurately represent our complication rates quoted. Nevertheless, we can conclude from these data that closure for a circumcision using a continuous suture technique gives favourable outcomes with acceptable complication rates.

Level of evidence:

Not applicable for this multicentre audit.

Paediatric sutureless circumcision--an alternative to the standard technique

INTRODUCTION

Circumcision is one of the most commonly performed surgical procedures in male children. A range of surgical techniques exist for this commonly performed procedure. The aim of this study is to assess the safety, functional outcome and cosmetic appearance of a sutureless circumcision technique.

METHODS

Over a 9-year period, 502 consecutive primary sutureless circumcisions were performed by a single surgeon. All 502 cases were entered prospectively into a database including all relevant clinical details and a review was performed. The technique used to perform the sutureless circumcision is a modification of the standard sleeve technique with the use of a bipolar diathermy and the application of 2-octyl cyanoacrylate (2-OCA) to approximate the tissue edges.

RESULTS

All boys in this study were pre-pubescent and the ages ranged from 6 months to 12 years (mean age 3.5 years). All patients had this procedure performed as a day case and under general anaesthetic. Complications included: haemorrhage (2.2%), haematoma (1.4%), wound infection (4%), allergic reaction (0.2%) and wound dehiscence (0.8%). Only 9 (1.8%) parents or patients were dissatisfied with the cosmetic appearance.

CONCLUSION

The use of 2-OCA as a tissue adhesive for sutureless circumcisions is an alternative to the standard suture technique. The use of this tissue adhesive, 2-OCA, results in comparable complication rates to the standard circumcision technique and results in excellent post-operative cosmetic satisfaction.

Modified safe technique for circumcision

We have used surgical gauze under the prepuceal skin as a pack in 20 cases prior to marking incision for circumcision. The prepuceal adhesions were first dissected and seperated. The method allows a stable, well-supported prepuceal surface for marking incisions and avoids injuries to the glans. Because the prepuceal surface is taut and stable, hemostasis is easier and quicker and the operating time is reduced.

The advantages of cyanoacrylate wound closure in circumcision

PURPOSE

To compare 2-octyl-cyanoacrylate (2-octyl-CA) glue with polyglytone 6211 sutures in circumcision wound closure on the basis of operative time, safeness, postoperative pain and cosmesis.

PATIENTS AND METHODS

The boys who would undergo circumcision in 18-month period (n = 137) were grouped into two. In Group 1 (n = 64), 6/0 polyglytone 6211 sutures, and in Group 2 (n = 73), 2-octyl-CA glue were used for wound closure. Durations of anesthesia, surgical procedures and postoperative pain, and pain scores on the 2nd and 48th postoperative hours were determined. A classification system was constructed to evaluate cosmesis, intraoperative and postoperative bleeding. Quantitative differences were assessed by Mann-Whitney U and Student's t tests, and qualitative analyses were performed by χ (2) test. p was considered as significant at less than 0.05.

RESULTS

The pain scores of the groups were comparable. Durations of anesthesia, surgical procedures and postoperative pain were significantly shorter (p < 0.05); and cosmesis, intraoperative and postoperative bleeding status were significantly better in Group 2 (p < 0.05).

CONCLUSION

2-Octyl-CA seems to be a good alternative to the conventional suturing technique in circumcision wound closure with shorter operation time, ease of appliance, improved safeness, better cosmesis and shorter duration of postoperative pain.

Sutureless skin closure with isoamyl 2-cyanoacrylate in pediatric day-care surgery

Importance of day-care surgery in pediatric age group is ever increasing and nowadays bulk of surgery is performed as a day-care procedure. Day-care procedure requires short intra-operative period and less postoperative complications. The introduction of tissue adhesive has been received enthusiastically since they may result in equivalent tensile strength-improved cosmetic appearance of the scar and lower infection rate when compared to sutures, staples and adhesive tape. We have used isoamyl 2-cyanoacrylate as a tissue adhesive for skin closure in day-care surgery. Novocryl is ideal for such procedure as it is a sterile, inert, non-toxic, biocompatible and bacteriostatic liquid topical skin adhesive containing isoamyl 2-cyanoacrylate formulation. We applied isoamyl 2-cyanoacrylate glue in 100 patients over skin cut margin after stitching subcutaneous tissue. Skin margin were held together by means of skin hook for 1-2 min. The cosmesis was better as there were no suture marks or lumpiness. There were no major complications in our study. Thus, isoamyl 2-cyanoacrylate can be considered as an alternative to skin suturing in the pediatric day-care surgery.

Wound approximation with tissue glue in circumcision

BACKGROUND

To assess the feasibility of using tissue glue in the approximation of circumcision wounds in children.

PATIENTS AND METHODS

A prospective randomized trial was carried out on 30 boys (age, 1-10 years) admitted to the Kahramanamaras Sutcuimam University Medical Faculty, Turkey. The results of wound approximation in circumcision with cyanoacrylate tissue glue and suturing with interrupted 5/0 plain catgut were compared. The operations were carried out by the same surgeon using an identical technique. The wounds were assessed 1 day, 3 days, 1 week and 1 month postoperatively.

RESULTS

There was no difference between the two groups in the rates of wound inflammation, infection, bleeding and dehiscence, although cosmetic appearance was better in the tissue glue group. The operation time was also shorter in this group.

CONCLUSION

Using tissue glue for wound approximation in circumcision is a feasible alternative.

Sutureless circumcision: a prospective randomised controlled study

Our aim was to study the advantages of glue versus sutures for circumcision in children. A randomised prospective controlled study was conducted with 152 boys; glue was used on 80 and sutures on 72. The procedures were quicker and the duration and severity of postoperative pain were significantly less (p < 0.001) in the cases in which glue was used. The tissue glue is a perfectly feasible alternative to sutures for circumcision in children and has potentially significant advantages.

Evaluation of octylcyanoacrylate for wound repair of clinical circumcision and human skin incisional healing in a nude rat model

PURPOSE

Alternative methods of circumcision wound closure have been studied to decrease repair time and complications, and improve cosmesis. This study includes a clinical and a laboratory research portion. Clinical parameters, wound outcome, closure time and operative time were compared for octylcyanoacrylate and suture approximation of circumcision incisions. An in vivo incisional model using human foreskin was used to compare the wound breaking strength of octylcyanoacrylate and suture repair.

MATERIALS AND METHODS

Circumcision incisions were closed with suture or octylcyanoacrylate. Wound closure time and operating room time were recorded. Patients were evaluated 1 and 12 weeks postoperatively. Foreskin samples from another group of patients were engrafted to an immunodeficient rat and allowed to heal. Incisions were made in the human skin and the wounds were repaired with sutures or octylcyanoacrylate. After 7 days breaking stress was tested and healing was evaluated by histological testing.

RESULTS

Optimal wound healing was noted in all patients 1 week after surgery. Scarring was absent in the octylcyanoacrylate group. Octylcyanoacrylate closure time was significantly shorter than suture time (p <0.001). Mean total operating room time for octylcyanoacrylate plus or minus standard deviation was shorter than for suture (19.4 +/- 0.51 versus 26.9 +/- 0.94 minutes, p <0.001). Octylcyanoacrylate wound breaking stress was equivalent to suture on tensiometry. Histological testing revealed normal healing in all wounds.

CONCLUSIONS

Circumcision wounds may be closed by octylcyanoacrylate with shorter wound closure and operative time than by suture. In an animal model of human skin healing, wound breaking stress after octylcyanoacrylate closure was equivalent to suture repair. Octylcyanoacrylate may be a useful alternative to suture closure for circumcision incisions.

A prospective randomized study of wound approximation with tissue glue in circumcision in children

OBJECTIVE

Bleeding and wound infection are the most common complications of circumcision. Cyanoacrylate tissue glue has been claimed to have the advantage of being haemostatic, bacteriostatic and easy to use. The purpose of this study is to assess the feasibility of using the tissue glue in approximation of circumcision wound in children.

METHODOLOGY

A prospective randomized trial was carried out on 86 boys consecutively admitted into the Duchess of Kent Children's Hospital, Hong Kong. The results of wound approximation with cyanoacrylate tissue glue and suturing with interrupted 4/0 plain catgut were compared. The operations were carried out by the same surgeon using identical technique except for the wound approximation. The wound was assessed 1 day, 2 days, 3 days, 1 week and 1 month postoperatively.

RESULTS

There was no statistically significant difference between the two groups in the rates of wound inflammation, infection, bleeding, dehiscence and cosmetic appearance, but the duration of operation was longer using tissue glue (19.8 min vs 16.5 min, P = 0.002).

CONCLUSIONS

We conclude that tissue glue approximation of circumcision wounds in children is a feasible alternative, but it offers no extra advantage when compared to suturing.

Phimosis: is circumcision necessary?

Circumcision has been the traditional treatment for phimosis, but now is not the only management option, the best of which appears to be topical steroid application. Importantly, the literature suggests that phimosis probably is over-diagnosed, indicating that a prospective, randomized controlled study is needed to compare the non-circumcision options. Such a study would require consensus on the diagnostic criteria for phimosis; therefore, a more exacting definition would be needed and is suggested. Despite the non-controlled data on medical treatment of true phimosis, there seems little doubt that surgical intervention is not needed for all male infants with adherence of the foreskin to the glans, a non-retractable foreskin or, indeed, true phimosis.