The World Health Organization’s manual on male circumcision listed the Plastibell technique as a well-proven paediatric method with respect to results and complications.
Although literature abounds on its wide acceptability, there are few multi-centred reports from this environment. The objective was to evaluate cases of infant circumcision by Plastibell device from two medical institutions.
Methods
All consecutive infants who had classical Plastibell circumcision (PC) at the Federal Staff Medical Centre, Abuja and the Lagos State University Teaching Hospital, Ikeja between February 2011 and June 2015 were included in this cross-sectional study.
The procedures were performed by surgical registrars and medical officers after ninety minutes of topical anaesthesia to the penis.
Data harvested from the standard proforma were analysed using Statistical Package for Social Science 20.0 for Windows.
Results
- A total of 2,276 infants had classical PC within the study period.
- Ages at circumcision ranged from 4 days to 3 months (mean age: 17 days).
- Majority were circumcised in the second week of life (n=1,394, 61.2%).
- Indications: religious (53%) and cultural (47%).
- Most common Plastibell size: 1.3 cm (n=1,040, 45.7%).
- Least common size: 1.6 cm (n=10, 0.4%).
- Mean device separation time: 6 days (range 4–12).
- No correlation between age and Plastibell size.
- Overall complication rate: 1.1%, with postoperative bleeding most common (n=12, 48%).
- No urethrocutaneous fistula observed.
- 17 cases (0.7%) of distal hypospadias detected; circumcisions postponed until repairs.
Conclusion
The main indication for infant circumcision in this environment was religious.
The Plastibell device has a good safety profile with few, easily correctable early complications.
Attention to ligature placement, appropriate device size, and thorough parental education are key to preventing post-procedure mishaps.
Study Adds to the Literature
- The main indication for newborn circumcision was religious.
- Reinforces the need for careful device size selection, proper ligature placement, and parental education to reduce complications.
Dr Khan’s Comments
- Mobile contact should be provided to parents for any postoperative question.
- Antibiotics were used in all cases of this study. In our practice, antibiotics are used in only 1:20 cases.
- Infection can still occur despite antibiotics.
- Bleeding incidence was 1.1%, which may require intervention.
- Age range was 1 to 3 months, with most procedures in the second week of life (62%).
In our experience, the ideal age for Circumplast or Plastibell is under one month.
- Ring falls off at around day 6 (range 4–12 days).
- Plastibell 1.3 cm is most commonly used.
- Parental education for aftercare is an important part of management.