Circumcision Complications: Our Eight-Year Experience

Research Article / Araştırma Makalesi Circumcision Complications: Our Eight-Year Experience Sünnet Komplikasyonları: Sekiz Yıllık Deneyimimiz Mustafa Erman DÖRTERLER 1 1 Harran University Faculty of Medicine, Department of Pediatric Surgery, Sanliurfa, Turkey Abstract Background: Most circumcision practices in our country are still carried out by medical officers or circumcisers. The present study aims to determine the types of circumcision complications, their frequencies and possible causes. Materials and Methods: A total of 103 patients between 0-18 years of age, who were admitted to the Pediatric Surgery Clinic of our hospital due to circumcision complaints between January 2012 and December 2019, were included in the study. The demographic data, treatments, and clinical follow-up of the patients were obtained from file records retrospectively. Results: The mean age of the patients was 3.9 ± 3.8 years. Of the circumcisions, 58 (56.3%) were performed at home or in a health cabin, while 45 (43.7%) were conducted in a hospital setting. Of these, 68 (66%) were performed by a circumciser or health officer, and 35 (34%) by a physician. The most common early circumcision complication was penile hemorrhage or hematoma (25.2%) and the most common late circumcision complication was inadequate circumcision and glans adherent skin bridges (17.5%). The major complications were glans penile amputation, necrosis, and excessive incision of the penis skin in 7 (6.7%) patients. Of these patients, 6 (85.7%) were circumcised by a health officer or circumciser. Conclusions: Circumcision is a surgical procedure that should be performed by specialist physicians where the necessary conditions for the surgical procedure are met. As society becomes more aware of this issue, the frequency of circumcision complications and the risk of severe complications will decrease. Key Words: Child, Circumcision, Complication, Surgery Sorumlu Yazar / Corresponding Author Mustafa Erman DÖRTERLER, MD Assistant Professor of Pediatric Surgery Harran University Faculty of Medicine Department of Pediatric Surgery Şanlıurfa, Turkey Telephone: +905053483200 Fax: +90 4143444444 E-mail: Geliş tarihi / Received: 02.07.2020 Kabul tarihi / Accepted: 24.07.2020 DOI: 10.35440/hutfd.762906 Öz. Amaç: Sünnet, dünyada en sık yapılan cerrahi işlemdir. Ülkemizde halen sünnetlerin büyük bir kısmı sağlık memurları veya sünnetçiler tarafından yapılmaktadır. Amacımız sünnete bağlı komplikasyon türlerini, sıklığını ve olası nedenlerini belirlemek. Materyal ve Metod: Çalışmaya Ocak 2012 ile Aralık 2019 tarihleri arasında sünnete bağlı şikayetler nedeni ile hastanemiz Çocuk Cerrahisi Kliniği’ne başvuran ve sünnet komplikasyonu saptanan 0-18 yaş arasında toplam 103 hasta alındı. Hastaların demografik verileri, uygulanan tedaviler ve klinik izlemleri retrospektif olarak dosya kayıtlarından elde edildi. Bulgular: Hastalarının yaş ortalaması 3,9±3,8 yıl saptandı. Sünnetlerin 58’i (%56,3) ev veya sağlık kabininde, 45’i (%43,7) hastane koşullarında yapıldı. Bunların 68’i (%66) sünnetçi veya sağlık memuru tarafından, 35’i (%34) doktor tarafından yapıldı. En sık erken dönem sünnet komplikasyonu penil kanama veya hematom (%25,2), en sık geç dönem sünnet komplikasyonu yetersiz sünnet ve glansa yapışık cilt köprüleri (%17,5) olduğu saptandı. Hastaların 7’sinde (%6,7) majör komplikasyon (glans amputasyonu, penis cildinde nekroz ve sünnet derisinin fazla kesilmesi) saptandı. Bu hastaların 6’sı (%85,7) sağlık memuru veya sünnetçi tarafından sünnet edildi. Sonuç: Sünnet, cerrahi işlem için gerekli şartların sağlandığı koşullarda uzman doktorlar tarafından yapılması gereken cerrahi bir işlemdir. Bu konuda toplumun bilinçlenmesi ile sünnete bağlı hem komplikasyonların sıklığı hem de ağır komplikasyon riski azalacaktır. Anahtar kelimeler: Cerrahi, Çocuk, Komplikasyon, Sünnet Harran Üniversitesi Tıp Fakültesi Dergisi (Journal of Harran University Medical Faculty) 2020;17(2):256-260. DOI: 10.35440/hutfd.762906 256 M.Erman DÖRTERLER Introduction Circumcision, as applied to males, is one of the most common surgical procedures in the world. Apart from medical reasons, circumcision is performed to protect against sexually transmitted diseases, as well as mostly for traditional and religious reasons (1,2). Surgical removal of the foreskin partially or completely to reveal the head of the penis is defined as circumcision. This surgical procedure is applied in almost every region of the world, although its frequency varies by region. Around 37-39% of males in the world are circumcised and this rate is much higher in Islamic countries (3,4). In Western society, circumcision is performed more frequently in the neonatal period due to medical indications, while in developing countries; circumcision is performed outside medical centers for traditional or religious reasons, mostly by people who have not received surgical training (5). Complications related to factors such as anatomical anomalies, clinical comorbidities, surgical methods used, and age of patients are seen in 1-4% of all circumcision procedures. When circumcision is performed without sufficient experience and in inappropriate conditions, the risk of complications increases even more (2,3). Circumcision complications are classified as early and late complications. Mild complications such as pain, bleeding, edema, and inadequate skin excision may occur in the early period, while infection, the formation of skin bridges between the penis shaft and the glans penis, urinary retention, meatal stenosis, meatal ulcer, and fistulas can be seen in the late period (2,6). Serious complications such as death and glans amputation may also occur, but rarely (5). In this study, the types and frequency of complications and their possible causes were investigated in relation to patients who were admitted to our hospital with circumcision complaints and who were determined to have complications related to circumcision. Circumcision Complications wound healing; repair for acquired hypospadias; antibiotherapy and dressing for infections; reimplantation for glans penis amputation (Figure 1); surgical revision for acquired phimosis, inadequate circumcision, and skin bridges adherent to the glans, penile curvature, and hemostasis; revision for penile hemorrhage or hematoma; meatoplasty for meatal stenosis; placement of a skin graft for necrosis in the penile skin, and excessive cutting of the foreskin (Figure 2); a dorsal slit application for plastibell induced strangulation of the glans, and bladder decompression for urinary retention. Figure 1. a) Total glans amputation view after circumcision, b) View after the reimplantation of penile glans. Materials and Methods A total of 103 patients, aged 0-18 years, who applied to our Pediatric Surgery Clinic in relation to complaints due to circumcision between January 2012 and December 2019, were included in this cross-sectional retrospective study. The age upon a (...truncated)