The Use of Tissue Glue for Circumcision in Children: Systematic Review and Meta-analysis 2018


To evaluate the efficacy of tissue glue in pediatric (children) circumcision.


A systematic review and meta-analysis of the English literature (1997-2017) was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement on children who underwent circumcision with tissue glue. Meta-analysis was conducted using RevMan 5.3, Comprehensive Meta-Analysis 2, and MedCalc 18. P values <.05 were considered significant.


The search returned 15 studies for a total of 4567 circumcisions, of which 3045 (66%) were performed with tissue glue. The systematic review indicated that overall complication rates were 4.3% (tissue glue) and 5.9% (sutures). The use of tissue glue was associated with reduced postoperative pain, better cosmetic results, and reduced cost. Meta-analysis showed that there was no difference between the incidence of total postoperative complications (relative risk [RR] 0.86 [95% confidence interval {CI}: 0.62-1.19], P = .36) and wound infection and dehiscence between the 2 groups (RR 0.95 [95% CI: 0.59-1.56], P = .85). Postoperative bleeding and hematoma formation were reduced with the use of tissue glue (RR 0.55 [95% CI: 0.32-0.95], P = .03). Tissue glue also significantly shorten the operative time (mean difference −0.22 [95% CI: −0.39 to −0.05], P = .01).


The incidence of postoperative bleeding and hematoma formation in pediatric circumcision is reduced with the use of tissue glue. Tissue glue has reduced operative time; furthermore, it might be associated with reduced postoperative pain, less overall cost, and superior cosmetic results.

Ref: UROLOGY 115: 21–28, 2018. © 2018 Elsevier Inc.

CQC published the case study- London Circumcision Clinic fulfils 95% standards

Case study – good practice for Newborn or Baby circumcision

This case study is taken from a GP practice that has conducted traditional circumcision for 28 years. ( published CQC website)

In this practice, parents receive written information and advice in advance of the procedure. This includes a consent form and information about aftercare. The practice requires both parents to give consent to the procedure.

Parents are advised not to feed the infant for two hours before the procedure. This ensures that the baby feeds immediately afterwards to provide comfort.

The doctor assesses the level and type of local anaesthesia appropriate for each infant, taking account of their age and weight and the requirements of the procedure. Pain relief is proportionate and appropriate for the individual needs of the infant.

If the doctor concludes that the procedure cannot be safely conducted in his GP practice, he advises parents of this and suggests alternative options (for example, referral to hospital care).

During the procedure, the infant is held comfortably still. Another person is always present to assist and respond to the infant’s needs if they are in any distress.

The family is advised to remain at the practice for at least an hour after the procedure and once the doctors is certain that the baby is not bleeding.

The doctor is available for aftercare and the arrangements for follow up are clear.

Written instructions for parents include a request to text or ring the doctor after their first check. The parents are advised to contact the doctor at any time by text or phone if they have any concerns. If this happens, the doctor will visit the baby at home or see him at the surgery, as is most appropriate.

The doctor encourages good practice among other providers by offering training in the procedure.


Advice for inspectors

Circumcision of male children

January 2016 Care Quality Commission

Circumcision for Balanitis Xerotica Obliterans (BXO) or Lichen Sclerosus foreskin - patient feedback

Adult patient who has Balanitis Xerotica Obliterans (BXO) or Lichen Sclerosus foreskin had circumcision by Dr Khan at London Circumcision Clinic 

"Can not recommend Dr Khan enough. The procedure was totally painless (minus the injections that do hurt but last 2/3 seconds). I was very worried about the future effects on my sex life from having circumscision and I’m happy to announce, if anything, things are better! I had to be circumscised because of BXO. The procedure lasted about 90 minutes. Things were very uncomfortable for around 7 days but the cream provided really hella relieve that feeling. The hardest thing to get used to is the (now exposed) head rubbing against underwear which can lead to some awkward, painful etections. Other than that everything post-procedure has been fine and like I said, things are working/feeling better than before. Don’t even worry about it."


Adult patient June 2018

Please see website for further information for Lichen Sclerosus or BXO and contact to Dr Khan for FREE telephone advice 

Feedback from patient with preputioplasty after tight foreskin (phimosis)

8th June 2018

Written by a patient at Leyton Healthcare 4th Floor, London Circumcision Clinic, London 

"My preputioplasty surgery went really well! Dr Khan was very reassuring and informative of the procedure. It was a quick and painless surgery, I was nervous but Dr Khan and his assistant kept me calm and comfortable throughout.  Being able to contact Dr Khan after the surgery was extremely helpful when it came to any concerns with swelling etc.  I would highly recommend anybody suffering from a tight foreskin to get in contact with Dr Khan. My results are amazing, I am really happy that I can now fully retract my foreskin without any pain! Wish I had done this sooner! "

Adult patient.