Comparative Study to Assess Paediatric Circumcision with the Plastibell Device Technique and Conventional Dissection Technique – A Prospective Randomised Trial

BACKGROUND Conventional Dissection Surgery (CDS) and Plastibell Device (PD) are the commonly used techniques for male circumcision. We wanted to evaluate and compare the postoperative problems and aesthetic results, and the patient’s / parent’s acceptance, of the two techniques of circumcision in boys. METHODS This was a prospective study in which children in the age group 0 - 12 years attending the surgery outpatient department for various indications of circumcision were enrolled on the basis of a predefined inclusion and exclusion criteria. The subjects were randomized and allocated into two groups, group PD and group CDS. Group PD was subjected to circumcision by Plastibell device technique. Group CDS was subjected to circumcision by conventional dissection technique. Duration of the circumcision and intra-operative complications if any were recorded, from starting the retraction of prepuce to completion of the procedure. Early and late complications were also compared during follow-up visits. Statistical analysis was performed using the Strata Software Version 10.0. P value less than 0.05 was taken as statistically significant. RESULTS The mean age of children in PD and CDS group was found to be 5.30 ± 3.29 years and 5.58 ± 3.66 years respectively. The mean age of patients in both the groups was found to be comparable with no statistically significant difference. According to Kayaba’s classification type 1 and type 2 (41.4 %) prepuce were most common in both the groups. Phimosis, ballooning of prepuce and recurrent urinary tract infection were common indications for circumcision in our study. Mean surgical time was 5.91 ± 1.74 in the P D group and 23.52 ± 5.94 in the CDS group which was statistically highly significant (P = 0.0000). Bleeding, cicatricial scar and adhesions were more common in CDS group, whereas dysuria and swelling were more common PD group and the difference was statistically significant. Children required less analgesia in CDS group. The average rate of late complications was significantly less in PD group as compared to CDS group (P = 0.006). CONCLUSIONS Circumcision by Plastibell device was comparable with conventional dissection technique in paediatrics age group. However, from aesthetic perspective, parents of Plastibell group appeared to be more satisfied than conventional dissection group. KEYWORDS Circumcision, Plastibell Device, Conventional Dissection Surgery, Complications