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| |  Electrocauterisation Can Safely Replace the Scalpel in Sutureless Circumcision: Presented at AAP By Crina Frincu-Mallos, PhD WASHINGTON, DC -- October 28, 2009 -- Circumcision can be safely performed in children without the use of a scalpel and sutures, by combining electrocauterisation and a tissue adhesive, according to data reported here at the 2009 American Academy of Pediatrics (AAP) National Conference & Exhibition. Despite being one of the most commonly performed operations in the United States, male circumcision, especially in neonates, is very controversial. In the most recent policy statement looking at the benefits versus risks associated with circumcision, the AAP declared that circumcision is “not essential to the child’s well-being.”(1) However, recent studies indicated that reduced risks of genital cancer and urinary tract infection are among the health benefits of circumcision.(2) Furthermore, after randomised controlled trials showed that circumcision could help in preventing HIV infections, the World Health Organization now recommends it for control of the AIDS pandemic.(3) However, to date there are no studies showing that neonatal circumcision prevents HIV infection. Andrew J. Kirsch, MD, Children’s Healthcare of Atlanta, and Emory University School of Medicine, Atlanta, Georgia, and colleagues have previously reported on a simpler version of their sutureless circumcision technique, which employed the use of 2-octyl cyanoacrylate (2-OCA), a synthetic tissue adhesive used for skin closure after minor surgical incisions.(4) For the current retrospective analysis, the investigators evaluated the charts of paediatric patients subjected to either primary circumcision or circumcision revision between July 1, 2006, and October 1, 2008, at their institution. This cohort included both infants and children, ranging in age from 6 months to 12 years old. Jonathan D. Kaye, MD, Paediatric Urology, Emory University School of Medicine presented the data here October 18. In all paediatric patients, the surgeons made skin incisions with electrocautery, using a metal probe heated by electric current to remove the foreskin, then performed haemostasis with electrocautery and used either 2-OCA or 6-0 suture for skin closure, followed by applying an antibiotic ointment to the glans and the penis. A total of 348 circumcisions were performed using sutureless 2-OCA and 94 circumcisions using 6-0 sutures. Of the revised circumcisions, 171 involved using 2-OCA and 60 using 6-0 sutures. The investigators noted that the decision to use sutures was based on the paediatric resident’s request, in most cases. The sutureless operation combining electrocautery and 2-OCA was significantly faster, with a mean operative time of 11 minutes (range, 6-22 minutes), compared with the traditional circumcision of 33 minutes (range, 18-48 minutes; P < .05). The patients were followed up on average for 12 months (range, 1-27 months) and the number of adverse events reported was low, with a total of 4 paediatric patients being readmitted to the hospital due to bleeding (1 from each group). The investigators also noted the absence of suture tracks and suture sinuses in the 2-OCA groups. ]1. Pediatrics. 1999;103:686-693. [Presentation Title: Sutureless, Scalpel-Less Circumcision: Faster, Cheaper and Better. Abstract 8414]
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