Plastibell Device Circumcision versus Bone Cutter Technique in terms of Parent’s Satisfaction and Outcomes

Abstract

Objective:To compare the rate of complications of Plastibell and bone cutter circumcision technique and recognition of top worries and satisfaction rate in the mind of parents before and after the procedure of Plastibell device (PD) circumcision in infants less than 6 months of age.Methods:It was a descriptive prospective study conducted at department of surgery Sheikh Zayed Hospital, Rahim Yar Khan. Two hundred parents of infants of less than six months of age were recruited for this study. Infants were divided into two equal groups. Group I included Plastibell circumcision technique and Group II included Bone Cutter Circumcision technique. Data was analyzed using SPSS Version 17. Independent sample t-test and chi-square test was used to compare quantitative and qualitative variables respectively. P-value <0.05 was taken as significant difference.Results:Total number of two hundred infants were included in this study. Most common worries of parents about Plastibell Device circumcision were; fear of fever (42.0%). Fear of pain and bleeding (66.0%). Plastibell Device method was associated with less operation time and bleeding as compared to bone cutter method (P-value <0.0001 and <0.0001 respectively). Incidence of complications other than bleeding and infection was 3.0% in bone cutter method and 1.0% in Plastibell device method. Pain score was significantly less in plastibell device group (p-value <0.0001). Post-operatively, 98% parents showed complete procedural satisfaction in Plastibell group versus 87% parents in bone cutter one month after surgery (P-value 0.003). About 4% parents in bone cutter method group showed cosmetic displeasure versus only 1% parents in plastibell device group.Conclusion:The study concluded that Plastibell Device circumcision is a safer technique for circumcision and is associated with highest level of parent’s satisfaction.

Bone cutter versus plastibell device in neonatal circumcision: A randomized trial

“…Similarly, complication rates were comparable between the 2 techniques. In the current study, the amount of blood loss and the duration of operation were less with bone-cutter circumcision compared to the plastibell device in contrast to the finding by Mehmood et al [23], who found more blood loss and longer duration of operation among infants who had bone-cutter technique compared to plastibell device. Though the duration of surgery in our study was comparable to theirs, the amount of blood in their study of 10.65±3.31mls for bone-cutter and 5.48±0.84mls for plastibell device was higher than ours.…”

“…In our study, we recorded a complication rate of 6.7% for the plastibell device and 5.0% for the bone-cutter method which are in agreement with the above studies. Mehmood et al [23] in a similar study, reported complication rates of 3% and 1% for bone-cutter and plastibell techniques, respectively. Bawazir [30] noted more complications with plastibell compared to the Gomco clamp.…”

“…[16,33,34] On the other hand, tragic complications such as urethrocutaneous fistula, and traumatic amputation of the glans in bone-cutter circumcisions have been documented in other studies. [23,35] While Mahamat et al [35] reported 3 cases of glans amputation in their series, Salle et al [13] report 6 cases in their study. Partial or complete amputation of the glans or penis, though a rare accident is regarded as one of the most severe complications of amputation that result from the incompetence of the practitioner using clamp and shield technique.…”

“…Many studies suggested that plastibell circumcision is a simple method and minor complications include local sepsis, bleeding, bell impaction, dysuria, incomplete separation of plastibell device, proximal migration of the ring, and excessive or inadequate skin removal. [17,23,29] However, case series of significant complications have also been reported. This includes necrotizing fasciitis, urinary retention, and glans necrosis.…”

“…[22] While the use of plastibell device has gained acceptance worldwide, studies comparing its use with the bone cutter for circumcision are rare. [23] In this study we compared the plastibell technique with the Guillotine method using a bone cutter, taking note of all possible complications that may follow each of the techniques, cosmetic outcome, and parental satisfaction.…”