Outcome of harmonic scalpel circumcision in children with hemophilia

Abstract

Background: There are many techniques described to decrease the risk of bleeding after circumcision in patients with bleeding diathesis such as monopolar diathermy, bipolar scissors and fibrin glue. Up to our knowledge, no previous study described the use of the harmonic scalpel in patients with bleeding diathesis. Our aim was to evaluate postoperative outcome after harmonic scalpel circumcision in boys with hemophilia.Methods: This was a prospective observational study carried out in Sohag University Hospitals, Sohag, Egypt. The patients were recruited from Outpatient pediatric hematology clinic from January 2014 till January 2017. All procedures were done under general anesthesia. After strict sterilization, the dorsal aspect of the prepuce was incised using harmonic scalpel up to the coronal sulcus, then the whole prepuce was cut circumferentially using the harmonic scalpel. It is a sutureless technique.Results: 26 boys with hemophilia A and 5 with hemophilia B were included. Their median age was 5 and 8 years respectively. The most common indication for circumcision was religious (20/31), the intraoperative blood loss ranged between 0-5 ml, operative time ranged between 3-5 minutes, there was no intraoperative complication, one case of rebleeding managed conservatively by factor administration, two cases of wound infection responded to antibiotic therapy, hospital stay ranged between 1-3 days. It was a sutureless technique.Conclusions: Harmonic scalpel circumcision is a safe technique in children with hemophilia, it decreased the risk of rebleeding, decreased operative time and it is also a sutureless technique and may decrease the cost by reducing the amount of factor replacement.