The role of 2-octyl cyanoacrylate in prevention of penile adhesions after circumcision: A prospective, randomized trial Hanna Alemayehu, Nicole E. Sharp, Katherine Gonzalez, Ashwini S. Poola, Charles L. Snyder, Shawn D. St. Peter ⁎ The Children's Mercy Hospital, Kansas City, MO, United States abstract article info Article history: Received 16 August 2017 Accepted 28 August 2017 Available online xxxx Key words: Circumcision 2-Octyl cyanoacrylate Penile adhesion Purpose: Penile adhesions are the most common complication after circumcision, although strategies to decrease them are poorly studied. We conducted a prospective, randomized trial comparing the use of 2-octyl cyanoacry- late (glue) skin adhesive to hydrophobic ointment after circumcision. Methods: Patients b 7 years old undergoing circumcision were randomized to glue around the sutures and corona of the penis or antibiotic ointment. The primary outcome variable was postoperative penile adhesions. Utilizing a power of 0.8 and an alpha of 0.05, 168 patients were calculated for each arm. Because of high attrition, we planned to include up to 500 patients. Presence/absence of adhesions was evaluated 2–4 weeks postop. Parents subjectively scored happiness, comfort, distress, and concern on a Likert scale 1–5. Results: From 11/2012 through 7/2016, 409 patients were enrolled. Adhesion data were available on 243 patients. There was no difference between glue (16.8%) and those with antibiotic ointment (15.2%) (p = 0.88) or in parental satisfaction across all areas measured. 165 patients were lost to follow-up, evenly distributed between the two groups (38% vs. 42%, p = 0.49). Conclusion: The placement of 2-octyl cyanoacrylate skin adhesive does not decrease the rate of postoperative penile adhesions after circumcision. Parent satisfaction outcomes are similar. Type of study: Treatment study. Level of evidence: Level II. © 2017 Elsevier Inc. All rights reserved. Circumcision is one of the most common procedures performed around the world [1]. The most common complication after circumci- sion is penile adhesions followed by bleeding, infection, incomplete circumcision, excessive skin removal, recurrent phimosis, epithelial inclusions cysts and meatal stenosis [1]. There are two etiologies of postoperative adhesions. First is incom- plete release of the natural adhesions, which is rare with freehand circumcisions. The second occurs when the raw surfaces on the glans and preputial collar fuse postoperatively [1]. These may be treated with steroids, in office adhesiolysis, or may require another procedure [2–5]. The most recent circumcision opinion from The American Academy of Pediatrics (AAP) comments that the rate of postcircumcision complications, including adhesions, is largely unknown because of the paucity of literature on the subject, and variability in the reported adhesion rate [1]. In our institution, some surgeons have utilized skin glue placed on the sutures and corona of the penis after circumcision in an attempt to prevent adhesions. To date there has been no literature on the use of 2-octyl cyanoacrylate skin glue to prevent recurrent adhesions after circumcision. The objective of this study is to evaluate whether application of 2-octyl cyanoacrylate skin adhesive decreased the incidence of adhesions after circumcision. We hypothesized that the incidence of adhesions will be decreased with use of 2-octyl cyanoacry- late skin adhesive. The secondary objective was to assess parent satisfaction and comfort level after circumcision with and without the use of 2-octyl cyanoacrylate skin adhesive. 1. Methods Approval was obtained from the institutional review board (IRB #1290443) prior to enrolling patients in this study. Children were subsequently enrolled after obtaining informed permission from the legal guardian. Assent was waived as all patients included were younger than 7 years and therefore unable to assent. The enrollment process occurred prior to the time of the operation. The permission forms and consent process were audited by the IRB on a continuing basis. The Journal of Pediatric Surgery xxx (2017) xxx–xxx ⁎ Corresponding author at: Center for Prospective Clinical Trials, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, United States. Tel.: +1 816 983 3575; fax: +1 816 983 6885. E-mail address: sspeter@cmh.edu (S.D. St. Peter). http://dx.doi.org/10.1016/j.jpedsurg.2017.08.052 0022-3468/© 2017 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg Please cite this article as: Alemayehu H, et al, The role of 2-octyl cyanoacrylate in prevention of penile adhesions after circumcision: A prospective, randomized trial, J Pediatr Surg (2017), http://dx.doi.org/10.1016/j.jpedsurg.2017.08.052