Safety, Complications, and Procedural Efficiency of Neonatal Circumcision Devices: A Network Meta-Analysis

This study aims to compare safety, complications, and procedural characteristics of commonly used circumcision devices in neonates and early infants.

We searched PubMed, EMBASE, Web of Science, and SCOPUS through January 2026 for randomized controlled trials comparing infant circumcision devices (Plastibell™, Mogen™, ShangRing™, AccuCirc™) in infants ≤3 months. The primary outcome was total adverse events; secondary outcomes included bleeding, infection, redundant skin, adhesions, parental satisfaction, and procedure time. A random-effects network meta-analysis estimated relative effects with 95% confidence intervals (CI), using Gomco™ or Mogen™ as reference devices. Analyses were performed in R.

Ten trials including 3,984 infants from Africa, the Middle East, and the United States were analyzed. No device differed significantly from Gomco™ in total adverse events: Plastibell™ (risk ratios, [RR] 1.53, 95% CI 0.56-4.21), ShangRing™ (RR 2.70, 95% CI 0.31-23.66), Mogen™ (RR 3.83, 95% CI 0.97-15.17), and AccuCirc™ (RR 9.62, 95% CI 0.24-388.45). Plastibell™ was associated with a higher infection risk versus Gomco™ (RR 4.25, 95% CI 1.43-12.65). No significant differences were observed in bleeding, redundant skin, adhesions, or parental satisfaction. Mogen™ and ShangRing™ had shorter procedure times than Gomco™ (mean difference [MD] -3.29 minutes, 95% CI -4.82 to -1.76; MD -3.39 minutes, 95% CI -6.11 to -0.67).

Neonatal circumcision devices demonstrate generally comparable safety profiles, though Plastibell™ carries elevated infection risk. Mogen™ and ShangRing™ offer procedural efficiency advantages. Device selection should prioritize provider expertise, infection control capabilities, and programmatic efficiency requirements alongside safety considerations.