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

Abstract

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.

Keywords: Circumcision; Infants; Local anesthesia; Modified Plastibell technique; Risks of general anesthesia..

Fig. 1

a Dorsal slit. b Plastibell placement. c Foreskin Division. d Dorsal and Ventral Stitches. e Complete circumcision