PEDIATRIC SURGERY INTERNATIONAL: Common circumcision complications are best avoided by making the practice uncommon

Working hard to cut through the email back log related to MC_HIV. However, this one jumps to the head of the line.

Late complications of newborn circumcision: a common and avoidable problem

Journal: Pediatric Surgery International
Publisher: Springer Berlin / Heidelberg
ISSN: 0179-0358 (Print) 1437-9813 (Online)
Category: Original Article
DOI: 10.1007/s00383-010-2566-9
Subject Collection: Medicine
SpringerLink Date: Sunday, February 14, 2010

Rafael V. Pieretti¹ , Allan M. Goldstein² and Rafael Pieretti-Vanmarcke³

(1)	Section of Pediatric Urology, Massachusetts General Hospital, Boston, USA

(2)	Department of Pediatric Surgery, Massachusetts General Hospital, Boston, USA

(3)	Department of Surgery, Massachusetts General Hospital, Boston, USA

Accepted: 1 February 2010  Published online: 14 February 2010

Abstract

Purpose:

The purpose of this paper is to study the types of operative and post-operative late complications resulting from newborn circumcisions and to make recommendations to prevent them.

Methods:

After obtaining IRB approval, a retrospective review of the late complications resulting from newborn circumcisions treated at the MassGeneral Hospital for Children from January 2003 to December 2007 was undertaken. The source used was the consultation notes and operative reports of affected patients. Additionally, cases seen in the outpatient Pediatric Urology Clinic from April 2007 to April 2008 were reviewed.

Results:

A total of 8,967 children were operated during the study period, of which 424 (4.7%) were for complications resulting from previous neonatal circumcision. Penile adhesions, skin bridges, meatal stenosis, redundant foreskin (incomplete circumcision with uncircumcised appearance), recurrent phimosis, buried penis and penile rotation were the most frequent complications. At the outpatient clinic of the Section of Pediatric Urology, 127 boys with concerns following newborn circumcision were evaluated, representing 7.4% of the total volume of cases seen in this clinic.

Conclusions:

Our results indicate the need to undertake a collaborative study to define the incidence of complications following newborn circumcisions, which should be performed by practitioners with adequate training in the technique of their choice and its post-operative care.

Keywords  Circumcision - Complications - Newborn

---

Rafael V. Pieretti Email: rpieretti@gmail.com

My response:

Dear Dr. Pieretti,

A radical but 100% effective approach to eliminating late complications from newborn circumcision is a concerted effort to avoid doing them in the first place. The simplest, most direct, and the least invasive approach to surgical complication has always been to reduce or eliminate the need for surgery. In this instance, there is no need in the neonatal period for circumcision. Therefore, the choice should be easy. If you believe otherwise, you are trapped in a mind set that encourages waste and clinging to tradition at the expense of the defenseless.

Best,
 
DAVID WILTON
(415) 669-4059 - text or voice
http://www.davidwilton.com/