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The Gomco Clamp showing components, in a range of sizes, that are assembled during the procedure described in the text. Procedure: First of all, a dorsal slit is made in the foreskin and the foreskin is separated from the glans. The bell of the Gomco clamp is then placed over the glans, and the foreskin is pulled over the bell. The base of the Gomco clamp is placed over the bell, and the Gomco clamp's arm is fitted. After the surgeon confirms correct fitting and placement (and the amount of foreskin to be excised), the nut on the Gomco clamp is tightened, causing the clamping of nerves and blood flow to the foreskin. The Gomco clamp is left in place for about 5 minutes to allow clotting of blood to occur, then the foreskin is dissected off using a scalpel. The Gomco's base and bell are then removed, and the penis is bandaged. It is a fairly bloodless circumcision technique. The circumcision is relatively quick compared to the Plastibell. It was the most popular method for circumcisions between 1950 and 1980 and is still common today, especially in the USA. A training video of a neonatal Gomco circumcision using dorsal penile nerve block and a sucrose pacifier, conducted by Dr Richard Green, Stanford University School of Medicine, is available at Dr Sam Kunin, an experienced urological surgeon in Los Angeles, has developed a clever, and very effective, method in which local anaesthetic is injected into the distal foreskin (Kunin, 2007b). Doing so separates the inner and outer foreskin therefore allowing the inner layer to be pulled against the bell of the Gomco clamp, and results in a maximum amount of inner layer being removed (). He points out that the inner lining is the area most prone to adhesions, irritations, yeast and bacterial infections, particularly in diabetics. Gomco clamps exist in sizes from neonatal to adult. Suturing is required post-infancy.
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Introduction
The new WHO guidelines recommend offering pre-exposure prophylaxis (PrEP) to people who are at substantial risk of HIV infection. However, where PrEP should be prioritised, and for which population groups, remains an open question. The HIV landscape in sub-Saharan Africa features limited prevention resources, multiple options for achie...
Background:
Uptake of voluntary medical male circumcision (VMMC) among adult men has fallen short of targets in Tanzania. We evaluated a smartphone raffle intervention designed to increase VMMC uptake in three regions.
Methods:
Among 7 matched pairs of health facilities, 1 in each pair was randomly assigned to the intervention, consisting of a w...
Background
Male circumcision reduces men's risk of acquiring HIV and some sexually transmitted infections from heterosexual exposure, and is essential for HIV prevention in sub-Saharan Africa. Studies have also investigated associations between male circumcision and risk of acquisition of HIV and sexually transmitted infections in women. We aimed t...
Background
Assessing safety outcomes is critical to inform optimal scale-up of voluntary medical male circumcision (VMMC) programs. Clinical trials demonstrated adverse event (AE) rates from 1.5 to 8 %, but we have limited data on AEs from VMMC programs.
Methods
A group problem-solving, quality improvement (QI) project involving retrospective char...
Citations
... 7 8 Male circumcision provides significant protection against HIV transmission and other sexually transmitted infections (STIs) in men. [9][10][11][12][13][14][15] This has been proven by randomised controlled trials in South Africa, Kenya and Uganda, 13 16 17 showing that circumcised males were less likely to become infected with HIV. As a result, male circumcision is increasingly recommended as a strategy to reduce HIV transmission, particularly in areas with a high prevalence of HIV. ...
Objectives
To synthesise evidence to determine whether, in contrast to medical male circumcision, traditional male circumcision (TMC) practices may contribute to HIV transmission and what the impacts of TMC are on the initiates, their families and societies.
Design
Systematic review.
Data source
PubMed, CINHAL, SCOPUS, ProQuest, Cochrane database and Medline were searched between 15 and 30 October 2022.
Eligibility criteria
(1) Studies involving young men, young male adults, male adults and mixed male and female participants; (2) studies on TMC involving men living with HIV (married and non-married); (3) studies on TMC, HIV transmission and impact in low-income and middle-income countries; (4) qualitative, quantitative and mixed-method studies and (5) studies aimed at exploring TMC and how it contributes to HIV transmission and the impacts of HIV on circumcised men and their families.
Data extraction
Data were extracted based on study details, study design, characteristics of participants and results.
Result
A total of 18 studies were included: 11 were qualitative studies, five were quantitative studies and two were mixed-method studies. All the studies included were conducted in areas where TMC was performed (17 in Africa and one in Papua New Guinea). The review’s findings were categorised into themes: TMC as a cultural practice, consequences of not being traditionally circumcised on men and their families and TMC-related risk of HIV transmission.
Conclusion
This systematic review highlights that TMC practice and HIV risk could negatively impact men and their families. Existing evidence suggests that little attention has been paid to men and their families experiencing the impacts of TMC and HIV risk factors. The findings recommend the need for health intervention programmes such as safe circumcision and safe sexual behaviours following TMC and efforts to address psychological and social challenges in communities practising TMC.
PROSPERO registration number
CRD42022357788.
... The excess foreskin was trimmed from around the bell using iris scissors. The handle was then broken off the device (11) . Thermal assisted circumcision (Group C) : ...
... Despite the heated controversy, circumcision during infancy may offer a "window of opportunity" since it may be linked with reduced expenses, a decreased risk of complications when carried out in a suitable setting by a skilled practitioner, and a less negative psychological impact on the kid. Additionally, because infants are less active than adults, the treatment may be done on them while they are under local anesthetic (11) . Additionally, male circumcision during the first year of life was advised by El Bcheraoui et al. (19) and Bicer et al. (20) because to the very low occurrence of adverse effects, which may increase up to 10-20 folds when performed beyond infancy. ...
... Major indications of circumcision include the religion, cultural, medical and recently public health reasons. [1,2] Circumcision has many other benefits such as protection against penile cancer, recurrent urinary tract infection, balanitis and sexually transmitted diseases. [3][4][5] Male circumcision is almost universal in our valley of Kashmir due to recommended practice of Islamic culture by Muslims. ...
... The removal of the foreskin and tissues that wrap the head of the penis is called circumcision. In the olden days, circumcision was performed for religious reasons, but nowadays, many parents get their sons circumcised for various reasons, including religion, culture, medical and so on [114,115]. As per reports of various studies, approximately 25-33% of the world's males are circumcised [116][117][118]. ...
Penile lichen sclerosis is a longstanding inflammatory disease of the skin with a controversial aetiology. Penile lichen sclerosis (PLS) is a growing, inflammatory dermatitis of the anogenital region, which involves the meatus, prepuce, penile shaft, and glans penis. Although the accurate aetiology of PLS is contentious, multiple factors including genetics, autoimmunity, infections of human papillomavirus, hepatitis C, Epstein-Barr virus, risk factors (hormonal and trauma), etc., can be considered to be a part of the etiopathogenesis of PLS. The initial clinical presentations of penile lichen sclerosis are white plaques, atrophied skin, erythema, erosions, and sclerosis in the anogenital region. When the disease advances, the following can occur, including meatal constraints, telangiectasia, petechiae, soreness, papular lesions, tightness of the foreskin, difficulties in passing urine, itching, tenderness on erections, pain, cracking, bleeding, redness, rashes, tightness at frenulum, and dysuria. This disease has a dangerous course of action and if untreated it may be linked with severe urologic and sexual morbidities. PLS is usually treated with medical and surgical interventions like topical or intralesional steroids and circumcision. The role of circumcision is very critical in the course of action and prognosis of PLS, and its treatment is dependent on the stage of the disease. This review brings up the knowledge regarding epidemiology, etiopathology, clinical presentation, and management of PLS with an emphasis on the role of circumcision.
... Major indications of circumcision include the religion, cultural, medical and recently public health reasons. [1,2] Circumcision has many other benefits such as protection against penile cancer, recurrent urinary tract infection, balanitis and sexually transmitted diseases. [3][4][5] Male circumcision is almost universal in our valley of Kashmir due to recommended practice of Islamic culture by Muslims. ...
Background: Male circumcision is recommended practice in Muslim tradition and one of the oldest operations performed all over the world.
Male circumcision is universal in our Muslim‑dominated valley of Kashmir for religious reasons. It can be performed by different techniques
such as the conventional open methods, the device methods and sutureless methods. The objective of this study was to report our practice of
male circumcision amongst children and compare the different common surgical techniques and highlight the circumcision mishaps conducted
by quacks in the Kashmir Valley. Materials and Methods: This was a comparative observational study conducted at SKIMS Medical College
and Hospital, from 2017 to 2021. Children who presented for primary circumcision were subjected to one of two different surgical techniques;
the dorsal slit or Guillotine method. The prospective analysis of children managed for circumcision mishaps conducted by non-professionals
was also included in the study. Circumcisions done after 2 years of age were defined as delayed. The data were collected analysed using SPSS
software (SPSS version 22, IBM, Armonk, NY, USA). Results: Total of 689 Kashmiri Muslim male children between 1 day and 10 years of age
over a period of 5 years were studied. Six hundred and fifty‑five children for primary circumcision and 34 children managed for circumcision
mishaps were included in the study. Amongst the subjects for primary circumcision, the most number of children were between 1 and 2 years of
age (33.28%). One hundred and fourteen (25.73%) hospital-delivered babies and 201 (94.81%) home-delivered babies had delayed circumcision
that is after 2 years of age (P = 0.00001). Religious requirement was the only indication for circumcision in this study. Three hundred and
ninety-six (60.46%) children were circumcised with dorsal slit and 259 (39.54%) with guillotine method using computer-generated random
numbers. Complications were found 8.08% of subjects in dorsal slit method as compared to 16.60% in guillotine technique (P = 0.008). Out
of 34 children managed for circumcision mishaps, 11 (32.35%) presented with massive bleeding after primary circumcision by half doctors,
18 (52.94%) had incomplete circumcision, 3 (8.82%) had multiple skin bridges and 2 (5.88%) had incomplete circumcision with glans injury.
All the patients with circumcision mishaps were treated with good outcome. There was no mortality. Conclusion: Circumcision occurs at a
wide range of ages and male circumcision is universal in our Muslim‑dominated valley for religious reasons. Circumcision by quacks and
the associated complications are still prevalent in our society. The procedure is safe and free of any major complications when conducted by
trained medical personnel under aseptic conditions of the operation theatre and hence should be encouraged
... 1 Steps in a routine circumcision using the NeoAlis clamp 1 . A: Administering local anesthesia using the penile ring block technique 2 ; B: Using the umbilicus as an anatomical landmark, the preputium is marked just showing the 12-o'clock plane, which will be kept on the same plane with the upper arm of the device after implementation of the circumcision device; C: The prepuce is further marked on the 6 o'clock plane using the median raphe as an anatomical landmark 3 ; D: A dorsal slit is made in cases with narrowed preputial neck 4 , that is, an inner tube is inserted inside the preputium, and the outer chamber is positioned in the unlocked position 5 The inner tube can also be placed through the preputium without performing a dorsal slit in children whose preputium is free of narrowing and phimosis. 5 : After placement of the inner tube just over the inner preputium mucosa and of the outer chamber just at the marked circumcision line, the surgical plane should be convenient; however, the inner mucosa can be further tailored by either pushing the mucosa using a baby-peanut sponge or retracting the mucosa using a blunt tipped mosquito clamp. ...
... A: Administering local anesthesia using the penile ring block technique 2 ; B: Using the umbilicus as an anatomical landmark, the preputium is marked just showing the 12-o'clock plane, which will be kept on the same plane with the upper arm of the device after implementation of the circumcision device; C: The prepuce is further marked on the 6 o'clock plane using the median raphe as an anatomical landmark 3 ; D: A dorsal slit is made in cases with narrowed preputial neck 4 , that is, an inner tube is inserted inside the preputium, and the outer chamber is positioned in the unlocked position 5 The inner tube can also be placed through the preputium without performing a dorsal slit in children whose preputium is free of narrowing and phimosis. 5 : After placement of the inner tube just over the inner preputium mucosa and of the outer chamber just at the marked circumcision line, the surgical plane should be convenient; however, the inner mucosa can be further tailored by either pushing the mucosa using a baby-peanut sponge or retracting the mucosa using a blunt tipped mosquito clamp. The supplementary video shows the described maneuvers. ...
Background
Circumcision has been one of the most commonly performed surgical procedures worldwide since ancient times. Given the popularity of this procedure, the aim of this study was to evaluate the effectiveness, reliability, and results of circumcision performed using the NeoAlisTM clamp and compare them with those obtained using the sleeve technique.
Study design
The results of 2259 patients circumcised using the two techniques were evaluated retrospectively. The patients who were circumcised using the plastic NeoAlisTM device were classified as group 1 and those circumcised using the sleeve technique were designated as group 2. The groups were compared in terms of operation time, results, cost, complications, and cosmetic satisfaction scores.
Results
A total of 1947 patients who met the inclusion criteria were included in the study. Group 1 consisted of 1454 patients, while group 2 comprised 493 patients. The total rate of complications, excluding bleeding in the form of oozing that stopped spontaneously, was 9.5% (n = 185). In group 1, the operation time was shorter, tolerability of local anesthesia was higher, satisfaction questionnaire scores were higher, cost was lower, and rates of early adhesion and meatal stenosis were lower. All of these parameters were significantly different from those in group 2. Notably, secondary phimosis was significantly higher in group 1. Although the bleeding that stopped with follow-up was significantly higher in group 2, there was no significant difference between the groups in terms of bleeding that required surgical intervention.
Discussion
Our study, which reports the results of circumcisions performed using the NeoAlis clamp, has the largest sample size in the literature. Moreover, this is the only study in the literature wherein the results of sleeve circumcision, which is a time-tested surgical procedure, and the results of NeoAlis clamp circumcision, which we applied to a large number of patients, were compared with each other and with the literature. The retrospective design that focused on relatively short-term (one month) results is the major limitation of this study.
Conclusion
Mass circumcision performed with a plastic clamp technique is safe, timesaving, easily teachable, and cosmetically advantageous.
... Circumcision means total or partial surgical excision of the prepuce. Commonly, it is performed for neonates but can be done at any age (1,2). All over the world, about 25-33% of males are circumcised (3). ...
Injury or even amputation of the glans or the penile shaft occurs rarely, but is a tragic circumcision related complication. Forceps guided technique is liable to this complication due to inability to visualize the glans before doing the incision. This study was designed; aiming to solve this problem by doing transillumination for the prepuce before doing the incision, thus exploring whether it contains any tissue between its layers and accordingly visualizing what is being done rather than performing the procedure blindly.
... [4] Plastibell It is a widely used technique around the world, it can be used in children up to 2 years as well as infants, and the incorrect technique can result in complications like pressure necrosis with injury to the glans as well as skin loss depending on bell sizes. The prepuce is pulled slightly forward and suture material is looped around in the groove and tied tightly, enough to cut off the blood supply to the prepuce distal to the groove, which withers and drops off in 7-10 days [5] [ Figure 1]. ...
... It is expected that laser/cautery method resulted in lower post-circumcision complications. 3,4,5 Tenascin-c is first discovered in muscle tissue and nervous system more than 20 years cellular signaling. These abilities are mediated through activation of pro-inflammatory cytokines and oncogenic signaling molecules. ...
Introduction In the era of personalized health, the quest for biomarker as tools of examination, of diagnosis and of follow up deemed necessary. In this study, the author analyzed the outcome of skin tissue repair dorsal-slit and laser (cauterization) through expression of tenascin-C. (TNC) is an extracellular glycoprotein expressed during embryogenesis and markedly increased in wound healing, especially in resolution phase.
Methods This study was conducted from July 2015 until May 2016 at Histology Lab FMUI and obtained ethical clearance from FMUI ethical committee no 751b/UN2.F1/ETIK/VIII/2015. Prepuces from 20 male participants (5-12 years old) were collected under signed informed consent and stained using hematoxylin-eosin staining to determine incisional margin area. Tenascin-C expression was determined by immunohistochemistry with ratio of TNC positive area and incisional margin area. Follow-up investigation was done using post-operative questionnaire and photographs to determine the status of wound healing.
Result The conventional group showed greater TNC expression (57.28± 47.56%) than cauterization group (25.36 ± 16.44%) (p=0.07). The mean expression of TNC in normal wound healing subjects (42.15 ± 40.87%) is slightly more than the mean of delayed wound healing subjects (38.83 ± 33.40%) (p=0.872). The number of subjects with normal healing after cauterization or conventional techniques is almost identical.
Conclusion The data presented here suggested that higher TNC expression indicate a trend toward normal wound healing. Further study with larger sample number is required.
Keywords: Circumcision, dorsal-slit, cauterization, tenascin-c, wound healing
... Another device used for this purpose is the AccuCirc (Figure 16), which was already tested in procedures performed by non-medical professionals. 83,[90][91][92][93] During history, for different reasons mostly non-medical, several alternative surgical techniques have been developed for the treatment of phimosis and may be termed as preputioplasty. In the twentieth century, 2 of them stood out: the preputial excision in "V", of Cloquet, that liberated the glans but maintained its natural cover; and the longitudinal incision in the stenotic distal foreskin followed by a transverse suture, attributed to Young's and Davies's Heinecke-Mikulicz. ...
