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Indian Journal of Surgery
Medknow Publications on behalf of Association of Surgeons of India
ISSN: 0972-2068
Vol. 67, Num. 1, 2005, pp. 55-55

Indian Journal of Surgery, Vol. 67, No. 1, January-February, 2005, pp. 55

Letter To Editor

Sutureless circumcision: Comments

Department of Plastic and Reconstructive Surgery, Central Jalma Institute for Leprosy, Tajganj, Agra - 282 001
Correspondence Address:Post Box 25, GPO, Mall Road, Agra - 282 001 Email:govindmalaviya@rediffmail.com

Code Number: is05013

Sir,

It was interesting to read the article by Sharma in October 2004 issue of the journal.[1] Circumcision, in spite of being one of the oldest and extensively performed surgical procedures, seems to be a technique not yet perfected, having a considerable complication rate.[2] The procedure can be conveniently performed under local anaesthesia, infiltrating the preputial skin circumferentially one cm proximal to the coronal rim. The glans can be anaesthetized by lignocaine jelly instilled into the preputial sac. This avoids a nerve block, which requires deeper injections.

The authors have used stay sutures at times and I feel instead of three, six can be used. Use of gauze dressings on top of the cyanoacrylate does not save much. The average healing period in their series was between 13 to 28 days (mean 21 days) and frenular junction took longer to heal. In the last paragraph of the discussion they have given the disadvantages of the glue in terms of shelf life and cost. Nothing has been mentioned about the time taken in performing circumcision with glue and with sutures at least in "normal" situations. Unfortunately a claim to this effect has been made in the abstract. Careful approximation of the edges appears to be an essential step and it takes more time.

I feel that there is no alternative to a good frenular stitch, properly applied biodegradable sutures (absorbable sutures other than catgut) and good hemostasis for cosmetically good results. The tension built up during erections can dislodge the glue in adults.

References

1.Sharma PP. Sutureless circumcision: Wound closure after circumcision with cynoacrylate glue - a preliminary Indian study. Indian J Surg 2004;88:286-8.  Back to cited text no. 1    
2.Williams N, Kapila L. Complications of circumcision. Br J Surg 1993;80:1231-6.  Back to cited text no. 2  [PUBMED]  

Copyright 2005 - Indian Journal of Surgery

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