Plastibell
The Plastibell Circumcision Device is a clear plastic ring with a deep groove running circumferentially designed for circumcising infant males. The Plastibell is placed onto the head of the penis during a 10 minute surgical procedure, and the device will fall off within 3 to 7 days. The Plastibell was invented by Hollister Inc in 1950, and first reported on in 1953.[1][2]
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[edit] Surgical description
A video of the Plastibell circumcision procedure done with EMLA, Lignocaine block is available at circumcision video
The Plastibell Circumcision Device is a clear plastic ring with handle designed for male neonatal circumcision that has a deep groove running circumferentially. The elective minimally invasive surgical procedure to install the Plastibell device may be performed by an OB/GYN, a pediatrician, a urologist, a family physician or a pediatric surgeon. The important issue is that the medical practitioner is trained in the procedure.
The adhesions between glans and foreskin are divided with a probe. Then the foreskin is cut longitudinally to allow it to be retracted and the glans (the head of penis) to be exposed. The Plastibell comes in 6 sizes. The appropriate one is chosen and applied to the head (the circumcision pictured at right is in this stage). The ring is then covered over by the foreskin. A ligature is tied firmly around the foreskin, crushing the skin against the groove in the Plastibell. Then the excess skin protruding beyond the ring is trimmed off. Finally, the handle is broken off at the end of the procedure. The entire procedure takes five to ten minutes, depending on the experience and skill of the surgeon.[3]
As with all circumcisions, the procedure should involve adequate anaesthesia, using either EMLA cream,[4] dorsal penile nerve block, penile ring block, or a combination of these prior to operation. The ring falls off in 3 to 7 days leaving a circumferential wound that will heal over the following week. Typically, the glans will appear red or yellow until it has cornified.
[edit] Advantages
The glans is protected during the procedure by the ring. Hemostasis (control of bleeding) is effective due to the ligature tie. Cosmetically, a predictable result is obtained due to the straight line of the ligature that causes the wound. It is a quick procedure once mastered - taking a few minutes to perform, and hopefully, relatively compared to 'normal' circumcision, causing less discomfort for the baby.
No bandage is required, allowing easy monitoring for infection.
Healing occurs while the edges of the prepuce are secured in the ring, making skin bridges (where the foreskin's end heals to the glans' corona) unlikely.
Cosmetically, there will be little to no circumcision scar, though as usual with any circumcision, there will be a color change where the (formerly) inner and outer layers of foreskin meet.
[edit] Disadvantages
The ring must fall off before final healing can occur. Rarely, the tip of the glans may protrude through the ring and become swollen, trapping the ring in place. Blood transfusion risk 1 in 30,000 procedures (Wiswell).
One study of 2000 Plastibell circumcisions found a complication rate of 1.8%.
The foreskin must be slit and forced from the glans to allow entry for the plastic dome.
Furthermore, because convalescence depends on a (temporarily) affixed medical device, risks of infection or hemorrhage due to the bell slipping or otherwise failing are greater[5] than a Gomco clamp or similar entirely-supervised circumcision. There are several reports in the literature of urinary retention after circumcision with the Plastibell device.[6] One case resulted in death.[7][8]
There also is a report of impetigo caused by Staphylococcus aureus when using the Plastibell.[9]
[edit] Prevalence
At least 50% of American non-therapeutic infant circumcisions since 1980 have been performed with a Plastibell.
[edit] Notes and references
- ^ Miller RL, Snyder; Snyder, DC (January 1953). "Immediate circumcision of the newborn male". Am. J. Obstet. Gynecol. 65 (1): 1–11. PMID 13016660.
- ^ Kariher DH, Smith TW (January 1956). "Immediate circumcision of the newborn". Obstet Gynecol 7 (1): 50–3. PMID 13280246.
- ^ Barrie H, Huntingford PJ, Gough MH (July 1965). "The Plastibell Technique for Circumcison". Br Med J 2 (5456): 273–5. doi:10.1136/bmj.2.5456.273. PMC 1845746. PMID 14310205. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1845746.
- ^ Russell CT, Chaseling J (January 1996). "Topical anaesthesia in neonatal circumcision: a study of 208 consecutive cases". Aust Fam Physician Suppl 1 (Suppl 1): S30–4. PMID 9479796.
- ^ Brennae, Mark (June 13, 2007). "Ontario boy dies after complications from circumcision". The Vancouver Sun (CanWest News Service). http://www.canada.com/vancouversun/story.html?id=cb3b8281-4134-46ba-85d3-b076072bda75&k=25810. Retrieved 2008-07-16.
- ^ Ly L, Sankaran K (5 August 2003). "Acute venous stasis and swelling of the lower abdomen and extremities in an infant after circumcision". CMAJ 169 (3): 216–7. PMC 167126. PMID 12900483. http://www.cmaj.ca/cgi/content/full/169/3/216.
- ^ Paediatrics & Child Health, Home
- ^ http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/vic/VCAT/2010/1772.html?stem=0&synonyms=0&query=anaesthetic
- ^ Stranko J, Ryan ME, Bowman AM (Sep-Oct 1986). "Impetigo in newborn infants associated with a plastic bell clamp circumcision". Pediatr Infect Dis 5 (5): 597–9. PMID 3763425. http://www.cirp.org/library/complications/stranko1/.
[edit] External links
- http://www.circlist.com/instrstechs/plastibell.html
- A video of dorsal penile and ring block and the Plastibell Circumcision
