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Complications of circumcision in Israel: a one year multicenter survey
Jacob Ben Chaim1, Pinhas M Livne, Joseph Binyamini
1Pediatric Urology Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. bc_je@netvision.net.il
Insights
Circumcision complications are rare in Israel, with most being mild and treatable. Both ritual circumcisions by Mohels and medical circumcisions by physicians show similar complication rates.
Area of Science:
- Pediatric Surgery
- Public Health
- Medical Ethics
Background:
- Neonatal circumcision is standard practice in Israel, traditionally performed by ritual circumcisers (Mohels).
- A growing trend among secular populations favors physician-performed circumcisions with local anesthesia.
Purpose of the Study:
- To assess circumcision outcomes in Israel.
- To compare complication rates between ritual and physician-performed circumcisions.
Main Methods:
- A retrospective review of 19,478 neonatal circumcisions performed in Israel in 2001.
- Data collected via questionnaires on procedure, performer, and complications.
- Complications evaluated in medical centers, including urgent and elective outpatient assessments.
Main Results:
- An overall circumcision complication rate of 0.34% was observed.
- Bleeding (24%) and excess skin (57%) were the most frequent complications.
- No significant difference in complication types was found between Mohels and physicians.
Conclusions:
- Circumcision complications are infrequent and generally mild in Israel.
- Both ritual and medical circumcision approaches demonstrate comparable safety profiles.
Background:
In Israel, virtually all children undergo circumcision in the neonatal period. Traditionally, it is commonly performed by a "Mohel" (ritual circumciser) but lately there is an increasing tendency among the educated secular population to prefer a medical procedure performed by a physician and with local anesthetic injection.
Objectives:
To evaluate the outcome of this procedure and to compare the complication rate following circumcisions performed by ritual circumcisers and by physicians.
Methods:
In 2001, of the 19,478 males born in four major medical centers in Israel 66 had circumcision-related complications. All the children were circumcised in non-medical settings within the community. The patients were medically evaluated either urgently due to immediate complications or electively in outpatient clinics later on. Upon the initial assessment a detailed questionnaire was filled to obtain data regarding the procedure, the performer, and the subsequent complications.
Results:
All the circumcisions were performed during the early neonatal period, usually on day 8 of life (according to Jewish law). in 55 cases (83%) it was part of a ritual ceremony conducted by a ritual circumciser (Mohel), while in 11 babies (17%) physicians were involved. Acute bleeding after circumcision was encountered in 16 cases (24%), which required suturing in 8. In addition, we found two cases of wound infection and one case of partial amputation of glans penis in which the circumcision was performed by a ritual circumciser. Among the late complications, the most common was excess of skin in 38 cases (57%); 5 children (7.5%) had penile torsion and 4 children (6%) had shortages of skin, phimosis and inclusion cyst. The overall estimated complication rate of circumcision was 0.34%.
Conclusions:
Complications of circumcision are rare in Israel and in most cases are mild and correctable. There appears to be no significant difference in the type of complications between medical and ritual circumcisions.
