Freehand (Sleeve) Resection

Sleeve resection is the most commonly used method for circumcisions in children older than 1 year. Some form of anesthesia (a regional nerve block or general anesthesia) is given. Two cuts are made side by side in the shape of a ring on the shaft of the penis. The skin between the cuts are removed and the two edges are sewn together. The location of the healed scar will depend on where the cut closest to the glans is made. Stitches used will absorb into the skin, so removal is not necessary. The procedure takes approximately 30 minutes and healing time is 3 weeks.

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Plastibell

A small child may occasionally be able to receive a circumcision using a plastibell or gomco clamp, methods usually reserved for infants. The Plastibell circumcision device is a clear lightweight plastic in the shape of a bell with an attached handle (see photograph).It comes in various sizes to fit newborns, infants and toddlers. The bell portion is designed to cover the glans while the foreskin is pulled over it and secured with a string (ligature). The ligature sits in a groove at the top of the bell so that when tied, the ligature will compress the excess foreskin, cutting off its circulation. The unwanted foreskin can now be removed by cutting around the bell while it protects the glans from injury. The key is choosing the correct size device since too large a bell will cause excessive tension on the remaining foreskin and pull the bell over the glans onto the penile shaft. On the other hand, too small bell size could result in either an inadequate amount of foreskin removed; also a small bell can put excessive pressure on the glans, causing a visible deformity. An experienced provider will chose the appropriate size device and perform the procedure in 5-10 minutes. Healing time is approximately 10-14 days.

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Gomco Clamp

The gomco clamp is a 4-part metal device which is in many ways similar to the Plastibell. It was designed in the 1930’s and quickly became the most popular method among doctors at the time. Like the plastibell its design allows for a safe circumcision by protecting the glans of the penis from injury. The amount of foreskin can be precisely determined and the line of excision is clean and regular. Also, aftercare is hassle-free (see after care instructions)

Like the Plastibell, technique, the foreskin is retracted and all connections between the foreskin and glans are loosened and removed. The foreskin is then pulled back over the glans and the proper-sized bell placed on the glans. The stem of the bell, along with the correct amount of foreskin to be removed, is pulled through a hole in the base plate of the clamp. After evaluating the amount of shaft skin remaining and making adjustments, the top plate (rocker arm) of the clamp is placed adjusted so it sits in the notch of the the base plate and secured by tightening its nut. The remaining (exposed) foreskin can then be cut using the edge of the base plate as a guide. The nut is then loosened, the base and top plate removed and the remaining shaft skin is lifted off the bell. A petroleum gauze dressing is then applied to the wound. The entire procedure is completed in 5-10 minutes and healing time is 10-14 days.

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Mogen Clamp

Similar to other circumcision methods, all adhesions between foreskin and the glans must be loosened, usually with a blunt probe. A mark is placed on the foreskin ,slightly below the corona (rim) of the glans; a hemostat is then placed in this position and locked.

The glans is felt between the thumb and index finger and pushed below the hemostat. The clamp can now be locked into place. All visible foreskin on the flat surface of the clamp is removed with a blade scalpel. The clamp remains closed for few seconds to avoid bleeding. After releasing the clamp, the remaining foreskin has a crush line that can be separated with the thumbs by pushing down on the sides of the shaft foreskin, towards the base of the penis. This maneuver exposes the entire glans. Petroleum gauze is placed on the glans to promote healing, which is completed in 10-14 days.

Unlike the Plastibell and Gomco techniques where the glans is protected by a bell device, the Mogen Clamp relies on the provider to recognize the location of the glans prior to closing the clamp. Though failing to perform this critical step could result in serious injury to the glans, choosing an experienced practitioner will avoid this rare event.