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Ann R Coll Surg Engl. 2009 July; 91(5): 436.
PMCID: PMC2758451
Technical Notes and Tips
Bruce Campbell, Section Editor

Paediatric Circumcision Using Bipolar Diathermy

BACKGROUND

Circumcision is the most commonly performed surgical procedure in males. The most common postoperative complication is bleeding with a reported incidence of 0.1–35%.1 Of such cases, 0.5% require a return to theatre.2 We advocate a technique, first described in 1999 in the urological press,3 that is simple to perform and has, in our hands, reduced this complication to zero.

TECHNIQUE

The foreskin is fully retracted and preputial adhesions are divided. The foreskin is replaced and the limit of the circumcision is marked on the prepuce. All incisions and resections are made using only the tips of the bipolar diathermy forceps from the skin through to the inner mucosal layer. The outer skin is incised and then a gross removal of the whole of the foreskin is carried out. The inner mucosa is then trimmed to length. The entire procedure is usually completed in a totally bloodless manner. The closure is with interrupted Polyglactin 910 using a horizontal mattress suture at the frenulum.

DISCUSSION

The above technique has been used on 181 boys with an average age of 8 years (range, 8 months to 15 years). There has been no incidence of postoperative bleeding requiring further surgical intervention. Diathermy can be safely used on the penis with satisfactory cosmetic result4,5 and use of the above technique appears to reduce the incidence of postoperative bleeding.

References

1. Kaplan GW. Complications of circumcision. Urol Clin North Am. 1983;10:543–9. [PubMed]
2. Cathcart P, Nuttall M, Meulen JVD, Emberton M, Kenny SE. Trends in paediatric circumcision and its complications in England between 1997 and 2003. Br J Surg. 2006;93:885–90. [PubMed]
3. Fearne C. Point of technique. Bloodless circumcision. BJU Int. 1999;83:717. [PubMed]
4. Fraser ID, Tjoe J. Circumcision using bipolar diathermy scissors: a simple, safe and acceptable new technique. Ann R Coll Surg Engl. 2000;82:190–1. [PMC free article] [PubMed]
5. Peters KM, Kass EJ. Electrosurgery for routine pediatric penile procedures. J Urol. 1997;157:1453–5. [PubMed]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England