med 18

 

Chapter 47 ■ Circumcision 351

a. Apply topical thrombin (Thrombostat) on absorbable

gelatin sponge (Gelfoam) or oxidized cellulose

(Oxycel, Surgicel); do not use circumferential dressing.

b. Silver nitrate and epinephrine have also been used

topically to control bleeding. To avoid local ischemia or systemic effects, do not exceed a 1:100,000

concentration of epinephrine.

Active Hemorrhage or Uncontrolled Ooze

1. Surgical assessment—ligation of bleeding vessel

2. Consider underlying coagulopathy.

G. Complications (Fig. 47.6)

The overall incidence of complications associated with circumcision ranges from approximately 0.2% to 7% (10–30)

1. Hemorrhage (14)

2. Infection (11,16,17)

More common with the Plastibell. Most are mild

and respond to wet to dry dressings and Sitz baths, but

fatalities have been reported

a. Local

b. Systemic (16)

c. Necrotizing fasciitis (17)

3. Incomplete circumcision (most common complication)

a. Phimosis

b. Skin bridge between penile shaft and glans (commonly due to inadequate skin removal and failure to

visualize the corona on follow-up examination)

c. Concealed penis (see also G14) (18)

4. Trauma

a. Urethral laceration during dorsal slit procedure

(avoided by keeping urethra in view at all times during the procedure)

b. Loss of penis (most commonly due to injuries

related to cautery) (20) /amputation of glans (10,12)

c. Hypospadias/epispadias

d. Cyanosis/necrosis of glans penis caused by overly

tight Plastibell, misplaced sutures, or overtight circumferential bandage (7,13)

e. Urethrocutaneous fistula associated with use of

Gomco clamp or Plastibell (most commonly

caused by using a Plastibell or clamp of incorrect

size or failure to recognize congenital megaloureter) (19)

5. Urinary retention (22)

a. Tight (or occlusive) dressing or glanular prolapse

through ring of Plastibell (21)

b. Meatal stenosis resulting from urethral meatitis (23)