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Circumcision is the most commonly performed surgical procedure in the world, with
one-third of males circumcised globally. Post-neonatal, prepubescent sutured circumcision
demonstrates complication rates ranging from 1.7% to 9.1%. We have previously reported
that 2-octyl cyanoacrylate (2-OCA, Dermabond, Ethicon) primary circumcision (PC) and
circumcision revision (CR) in prepubescent children demonstrated superior cosmesis,
shorter operating room (OR) times and cost savings.
The aim of our study is to evaluate complication and reoperation rates with a scalpel-free
and suture-less technique for primary circumcision (PC) and circumcision revision
(CR) using 2-OCA.
Following IRB approval, we conducted a retrospective review of all boys at our institution
who underwent PC or CR using 2-OCA and monopolar diathermy between January 2014 and
January 2021. All procedures were performed by a single surgeon. The technique is
outlined in the figure below. No aligning sutures or instruments were used in this
process. Patients that required sutures or compressive dressings based on age or associated
anomalies were excluded from analysis. We obtained all returns to our system within
30 days of the procedure and returns to the OR during the study period using the REDCap
Of 1107 procedures performed during the study period, 634 procedures (479 PC and 155
CR) met inclusion criteria. Median age was 12 months (range 3 months–10.4 years) with
minimum follow up of 1 year. There were 3 patients (0.47%) that returned to system
within 30 days for surgical site bleeding, and one patient (0.15%) required surgical
intervention within 30 days. Nine patients required reoperation after 30 days, five
(0.8%) for iatrogenic phimosis, 3 (0.5%) for redundant prepuce and 1 for keloid formation.
We observed an overall complication rate of 1.3% (6/634) and reoperation rate of 1.6%
Since FDA approval in 1998, 2-OCA has been widely adopted as a replacement for sutures
in tension-free wounds. However, it has yet to gain widespread use for circumcision
given concerns for wound dehiscence and surgical site bleeding. This study demonstrates
that a scalpel-free and suture-less technique demonstrates complication and reoperation
rates are lower than reported circumcision using scalpel and sutures. Limitations
include retrospective design, single surgeon experience, and REDCAP database only
identifying patients with complications that required a return to system.
In the late ’90s, a paediatric surgical resident was called to the emergency department to examine a neonate for a potential complication after ritual circumcision. The resident confirmed complete gangrene of the penile body following the application of an unconfirmed chemical substance to stop bleeding. Complete amputation of the penile body occurred a few days later. The circumcision was performed by a physician who seemed to be a relative to the child. This resident was me. Similar cases of penile gangrene after circumcision are reported in the literature [1–3].