* Dr. Iftikhar Ahmad Jan FCPS, FRCS Ed, FACS, FEBPS Associate Professor & Head, Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan Correspondence: Dr Iftikhar Ahmad Jan E-Mail: ifti1@cyber.net.pk * Received for publication: February 23, 2004 Revision accepted: May 26, 2004 Original Article CIRCUMCISION IN BABIES AND CHILDREN WITH PLASTIBELL TECHNIQUE: AN EASY PROCEDURE WITH MINIMAL COMPLICATIONS - Experience of 316 cases Jan IA * ABSTRACT: Introduction: Circumcision is the commonest surgery performed in the Muslims. In our country circum- cision is performed by barbers, medical technicians, quacks and doctors including paediatric surgeon. As yet there is no consensus for the best age and method for circumcision. Aim: To evaluate the safety of various methods of circumcision at different age groups and to suggest the best age & method of circumcision. Design and Method: A retrospective study was conducted to review the 316 consecutive circumcision performed by the author at Shifa International Hospital Islamabad from June 1998 to September 2001. All babies & children who underwent circumcision by the author were included in the study. Babies having circumcision as a part of hypospadias repair were excluded. Circumcision below two year was done by plastibell under local anaesthesia and circumcision above two years was performed by open technique under general anaesthesia. Results: Of the 316 circumcisions 227 (72%) were performed in the first week of life by the plastibell. 17 (5%) children had circumcision from 2-12 years of age mostly by open method. Overall incidence of complications was 2 % (7 patients). Two had bleeding from the circumcision site which was controlled by local measures. Bell impaction was seen in two patients at 1.6 years & 3 years age and parents of two babies were concerned about inadequate circumcision. Circumcisions performed in the neonatal period had minimal number of complications. Conclusion: Circumcision can be safely performed in a hospital set-up within first month of life prefer- ably in the first week if the baby is otherwise well. Plastibell is a safe method for babies under one year. Older children should have circumcision by open method. Plastibell can be a safe technique if performed by trained GPs under aseptic conditions. KEY WORLDS: Circumcision, Age, Complications, Method. Pak J Med Sci July-September 2004 Vol. 20 No. 3 175-180 INTRODUCTION Circumcision is the commonest surgery per- formed in the Muslims. In Pakistan circumci- sion is performed at all ages from newborn period to adulthood. Most doctors delay cir- cumcisions in the newborn period due to the fear of complications. With the wide spread use of circumcision device like plastibell the operative time has significantly decreased so is the incidence of complications if the basic principles of surgery are practiced 1 . Circumci- Pak J Med Sci 2004 Vol. 20 No. 3 www.pjms.com.pk 175