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Conventional vs. device-assisted paediatric circumcision: A systematic review and meta-analysis
Abdul-Hadi Kafagi1, Ahmed E Ibrahim2, Zaidi Hamid3
1Department of Urology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Objective:
To compare the safety, efficacy, and postoperative outcomes of conventional versus device-assisted techniques in paediatric circumcisions.
Methods:
Systematic review of all studies up to March 2025. Studies were identified from all major databases, including PubMed, the Cochrane Library, Scopus and Web of Science. All randomised controlled trials and prospective and retrospective cohort studies comparing conventional scalpel-based and device-assisted paediatric circumcision were included; studies involving patients older than 18 years were excluded. The primary outcomes were bleeding, bleeding requiring sutures, surgical site infection, edema, delayed healing or separation, reoperation or revision, urinary retention and inadequate skin removal. Operative time and financial costs were assessed as a secondary outcome.
Results:
Twenty-three studies involving 23,490 patients were included. Device-assisted circumcision was associated with significantly shorter operative time (P < 00.00001), reduced post-operative bleeding (P = 00.04), and fewer revision surgeries (P = 00.007) compared to conventional techniques. No significant differences were observed in bleeding requiring sutures (P = 00.08), surgical site infection (P = 00.07), delayed healing (P = 00.34), urinary retention (P = 00.45), edema (P = 00.59), or inadequate skin removal (P = 00.11). Subgroup analysis of randomised controlled trials (RCTs) confirmed a significantly shorter operative time with device-assisted techniques (P < 00.00001), with other outcomes showing consistent trends but not reaching statistical significance.
Conclusion:
Device-assisted paediatric circumcision appears to be associated with shorter operative times and reduced bleeding compared to conventional methods, with comparable rates of most complications. However, the evidence is limited by significant heterogeneity, variability in study quality, and a predominance of observational data. While the findings suggest potential advantages in high-volume or resource-limited settings, larger, well-conducted randomised controlled trials are needed to confirm these results and guide clinical decision-making.
