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Laser Circumcision Outcomes

Circumcision is a common paediatric surgical procedure done worldwide. The incidence of complications, which varies from 0.034% to 7.4% depending on the method used, ranges from minor problems to major complications.

The Department of Paediatric Surgery at KKH performs about 1100 to 1200 cases of childhood circumcisions per year. Almost all of these cases are performed using the carbon dioxide laser, which allows the procedure to be done quicker and safer, with minimal blood loss.

No complications occur in more than 97.5% of our procedures. Bleeding after the procedure is the commonest problem, but this occurs only in 1.82% of all cases and only 0.17% of patients need to return to the operating theatre (OT). Postoperative infection occurs in 0.22%, and in rare situations (0.09%), the patient experiences difficulty passing urine, which resolves spontaneously. The graph shows details based on data accrued from 2006 to 2007 with a total of 2309 patients who underwent circumcision.

Fig 1. Percentage of different type of post-circumcision complications at KKH in 2006-2007

Our complication rate is comparable with international figures. A review of the international literature has quoted morbidity rates for circumcision range from 0.5 to 10%1,2,3. A retrospective review of circumcision complications in England between 1997 and 20034 showed that 0.8% had haemorrhage, 0.5% required a return to theatre and 0.3% had infection or other complications. We had a higher post circumcision haemorrhage rate of 1.82%, but we had a lower rate of haemorrhage requiring return to OT, 0.17%. This means that the majority of complications were mild, not requiring repeat surgery.

Fig 2. Percentage of different types of post-circumcision complications in England in 1997-2003

References:

  1. Williams N, Kapila L. Complications of circumcision. Br J Surg 1993; 80: 1231-6.
  2. Griffiths DM, Atwell JD, Freeman NV. A prospective study of the indications and morbidity of circumcision in children. Eur Urol 1985; 11:184-7
  3. Fraser IA, Allen MJ, Bagshaw PF, Johnstone M. A randomized trial to assess childhood circumcision with the Plastibell device compared to a conventional dissection technique. Br J Surg 1981; 68: 593-5.
  4. P.Cathcart, M.Nuttall, J.van der Meulen, M. Emberton and S.E Kenny. Trends in paediatric circumcision and its complications in England between 1997 and 2003. Br J Surg 2006; 93: 885-890