"Bisection method" sleeve circumcision in patients with redundant prepuce and phimosis: a clinical comparative study

To investigate the differences in clinical efficacy among disposable circumcision suture device (DCSD), conventional sleeve circumcision (CSC), and the "bisection method" sleeve circumcision (BMSC) in the treatment of redundant prepuce and phimosis.

A total of 150 patients diagnosed with redundant prepuce or phimosis admitted from January 2025 to December 2025 were enrolled and stratified into three groups based on the surgical technique performed: DCSD group (n=30), CSC group (n=40), and BMSC group (n=80). Operation time, postoperative Visual Analogue Scale (VAS) pain scores, incision healing time, and complication rates (including edema, infection, and wound dehiscence) were compared among the three groups. Patient satisfaction regarding cosmetic outcomes of the incision was assessed via standardized questionnaire 1 month after surgery.

The DCSD group demonstrated significantly shorter operative time compared to both sleeve groups, with the DCSD group having the shortest duration, followed by the BMSC group, and the CSC group the longest [BMSC: CSC: DCSD (21.96±1.89) min vs (23.77±1.51) min vs (5.2 ± 1.56) min, P < 0.001]. The postoperative VAS scores from D0 to D7 were not statistically significant without adjustment; however, all became significant after age adjustment using ANCOVA (P = 0.011, 0.005, 0.012, 0.022), with the stapler group showing the highest VAS pain scores. Edema was the most common complication, with significantly lower incidence in the sleeve groups compared to the DCSD group. Other complications, including infection, wound dehiscence, and acute hemorrhage, occurred in too few cases for intergroup statistical comparison. Incision healing time was slightly shorter in the sleeve groups [BMSC: CSC: DCSD (14.06 ±2.4) days vs (14.03 ± 2.25) days vs (16.53 ± 2.75) days, P < 0.001]. At 1 month postoperatively, the proportion of "very satisfied" responses was higher in the two sleeve groups than in the DCSD group (66.25% vs 60% vs 43.33%, P =0.4080). No statistical difference in incision cosmetic score was observed among the three groups, though the sleeve groups showed a trend toward superior overall cosmesis compared with the DCSD group.

We propose a modified sleeve circumcision technique-the "bisection method" sleeve circumcision. The DCSD offers significant advantages in terms of high efficiency, minimal invasiveness, and procedural standardization. In contrast, both sleeve circumcision techniques demonstrate superior outcomes in postoperative pain control, edema incidence, and personalized aesthetic results. Among these, the BMSC is superior to the CSC in operation time and achieves favorable clinical application outcomes.