RE-AUDIT OF EARLY COMPLICATION ESPECIALLY IMPACTION OF DISPOSABLE DEVICE: IMPROVING OUTCOMES OF CIRCUMCISIONS WITH PLASTIBELL AND CIRCUMPLAST RINGS IN CHILDREN IN A COMMUNITY CLINIC
AIM: To evaluate the early postoperative complications particularly impaction of disposable devices ( Plastibell and Circumplast ) in children’s circumcision procedures under local anaesthesia between different age groups, size and types of rings, and different doctors in a community clinic.
MATERIAL AND METHODS
In our re-audit, the outcome of circumcisions (n=1449) was studied over a 1 year period (May 2016 to April 2017) performed under local anaesthesia, by trained doctors in a community clinic doing Circumplast Circumcisions (CC) (n=470) and Plastibell circumcisions (PC) (n=979). Data was collected prospectively and early postoperative complications especially ring impaction were compared between age of the child, size and types of device, and doctors who have performed the circumcision. Follow-up was arranged if required.
The mean age was 6.5±0.4 months (median 1.6). Overall complication rate was 6.7% (97/1449). There is no significant difference in overall complications rate in CC (7% n=33/470) versus PC (6.5% n=64/979) (p>0.5). Although ring impaction is significantly lower in Circumplast circumcision (0.4% n=2/470) versus Plastibell circumcision (3.4% n=33/979) (p<0.05) but it has significantly improved from the previous audit (CC 3.2% n=7/208 versus PC 8.7% n=102/1179 – ESPU 2016). There is significantly lower incidence in ring impaction with Plastibell size 1.4 as compared to 1.3, 1.5 and 1.7. There is no impaction in 1.1 and 1.2 sizes. Ring impaction was significantly lower in infants versus over 1 year child (1.5% vs 10% n= 19/1280 vs 17/169, p<0.5) respectively. There is no significant difference in complications (8.5%, 7.1%, 6.5%, 5.8% and 5%) among the five doctors’ cases (p>0.5). Mean follow-up for 354 (24%) children were 14 days (median 6).
This concludes that no significant difference noted in overall early complications of circumcisions between age of the child, size and types of device used, and among different doctors. However, ring impaction was significantly lower in infants, Plastibell size 1.4 and Circumplast.
Accepted as a poster and presentation in ESPU 2018. This abstract is published at https://congress2018.espu.org/
All children operated at Thornhill clinic, Luton, Leyton Clinic, London and Croydon Clinic, London