Experience with Plastibell Circumcision in Neonates and Infants In Ghana.

Abstract

Background: Plastibell circumcision is a method of circumcising male children. It is an easy, quick and safe technique with cosmetic results which meet with parental expectations. The procedure is performed using the plastibell clamp, which is a plastic protective bell that is placed over the glans and under the foreskin. Experience with this device has not been documented in Ghana. This study was thus undertaken to document experience with the use of plastibell device for circumcision in neonates and infants in a private general practice hospital in Ghana.

Methods: A prospective study of babies of consenting parents/guardians who had plastibell circumcision performed at the theatres of Narh Bita hospital, Tema between January 2006 and July 2009. Parents/guardians were given specific instructions on care of the device on discharge and followed up via telephone calls to determine day of separation of the plastibell. Review was mandatory on the seventh day if the device had not fallen off. Apart from babies that reported to the hospital, all guardians/parents were contacted on phone from the eighth to the fourteenth day to enquire when the plastibell dropped off. The complications encountered were also chronicled.

Results: 318 babies (245 neonates and 73 infants) participated. Age of the subjects: 5days to 86days with a mean of 24.46days with statistically significant difference (p=0.000) between age of neonates 11.06days and infants 47.26days. The mean weight was 4.45kg (2.2kg to 6.3kg). The modal plastibell size was 1.3cm in both groups. The feedback from telephone calls on separation day of the plastibell was however complete for 230 babies comprising 182 neonates and 48 infants giving a non-response rate of 27.7%. The mean number of days for plastibell to separate is 4.91days [SD 1.38] no statistically significant difference between the two groups with a range of 2 to 10days for all patients. The neonates had a mean below that of the cohort and the reverse was true for the infants. This difference nonetheless was not statistically significant. Overall, 21babies (6.6%) developed complications with proximal migration on the phallus requiring manual removal under general anaesthesia being the commonest. Sixteen (76.2%) were neonates and five (33.8%) were infants. The complications were manual removal of plastibell ring due to proximal migration on the phallus in nine babies (42.9%), haemorrhage typically from the frenulum in seven (33.3%), and conversion to conventional dissection method in five (23.8%). The latter complication usually arose as a result of inability to acquire the appropriate size of plastibell for logistic reasons. Six of the babies had mild hypospadias (1.9%) but this did not prevent the circumcision.

Conclusion: It took a shorter time for the plastibell to separate and with fewer complications in neonates than infants. It is therefore better suited for neonates and patient selection for the use of the plastibell should take this into cognizance. The modal size of 1.3cm will help institutions stock the right size for both neonates and infants. Though complications were present, they were few and could be managed provided the parent/guardian followed instructions given to them and returned to the hospital in good time. Further studies using larger numbers and more centers with the inclusion of parent/guardian satisfaction survey will be useful. Plastibell circumcision is safe for use in private hospital settings in Ghana.

Keywords: Circumcision; Male; Neonate; Infant; Ghana; Private Hospital