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Microscopic Replantation of Penile Glans Amputation Due to Circumcision
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Circumcision--what's wrong with plastic rings?

Peter S Millard1

  • 1Catholic University of Mozambique, Faculty of Health Sciences. pmillard@mac.com

South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|March 3, 2012
PubMed
Summary
This summary is machine-generated.

New circumcision methods using the Gomco clamp and tissue adhesive show promise for improving safety and efficiency in scaling up services. Further clinical trials are recommended to compare these techniques against traditional open surgical circumcision.

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Area of Science:

  • Urology
  • Public Health
  • Surgical Innovation

Background:

  • Open surgical circumcision techniques present challenges in terms of technical difficulty, resource utilization, complication rates, and healing time, particularly in resource-limited settings.
  • Existing approved methods face scrutiny, with a history of complications with plastic ring devices like the Tara KLamp.
  • The Gomco clamp has a long history of use in pediatric and adult circumcision in the USA, but lacks published adult studies.
  • Cyanoacrylate tissue adhesive offers advantages over sutures in circumcision, including improved safety, ease of use, reduced operative time, and better cosmetic outcomes.

Purpose of the Study:

  • To evaluate the efficacy and safety of novel circumcision techniques.
  • To identify circumcision methods that align with the World Health Organization's (WHO) criteria for ideal techniques.
  • To recommend further research comparing new methods with established surgical procedures.

Main Methods:

  • Evaluation of disposable plastic circumcision devices (Shang Ring, Prepex system) within the WHO framework.
  • Review of historical use and potential application of the Gomco clamp in adult circumcision.
  • Assessment of cyanoacrylate tissue adhesive as a closure method for circumcision.
  • Clinical experience in Mozambique using Gomco clamp circumcision with tissue adhesive closure.

Main Results:

  • Disposable plastic devices show potential but warrant caution due to past complications.
  • The Gomco clamp, combined with tissue adhesive closure, appears to meet WHO criteria for an ideal circumcision technique based on initial experience.
  • Cyanoacrylate tissue adhesive demonstrates superiority over sutures in key circumcision parameters.

Conclusions:

  • The combination of Gomco clamp circumcision and cyanoacrylate tissue adhesive closure is a promising technique for scaling up circumcision services.
  • Further clinical trials are strongly recommended to rigorously compare Gomco clamp plus tissue adhesive with open surgical circumcision in African populations.
  • This approach could potentially address the limitations of current open surgical methods and improve outcomes in large-scale circumcision programs.