Table 1.
Prospective studies of frequency of complications in studies of neonatal and infant circumcision
| Author | Country | No. of patients | Age | Type of provider | Method | Follow-up period | Frequency of adverse eventsa | Frequency of serious adverse eventsb |
|---|---|---|---|---|---|---|---|---|
| Al Samarrai [11] | Saudi Arabia | 2000 | 2-3 days | Junior staff with supervision | Plastibell | 6 weeks plus immunisation clinic visits | 1.4%c | 0% |
| Amird [21] | Saudi Arabia | 1000 | Mean 9 days | Surgeon | Gomco clamp | 1 year | 1.6% | 0% |
| Banieghbal[32] | South Africa | 583 | Neonatal | Surgeon | Gomco clamp | 1 month | 0.3% | 0% |
| Ben Chaim [9] | Israel | 19,478 | Mean 8 days | 83% Mohel 17% Physician |
Freehand | - | 0.1% | 0.1% |
| Bhat [22] | Oman | 250 | Neonatal (min 1 day) |
Paediatrician | Plastibell | - | 0% | 0% |
| Duncan [23] | Jamaica | 205 | Neonatal | Surgeon | Plastibell | 1 week | 1.5% | 0% |
| Horowitz [24] | USA | 130 | 98 neonatal 32 infants (3-8.5 months) |
Pediatric urologist | Gomco clamp | 3 days | Overall: 7.4% Neonatal: 0% Infants: 30% |
0% |
| Manji [25] | Tanzania | 368 | 7 days to 9 months | Pediatrician | Plastibell | - | 2.8%e | 0% |
| Mousavi [33] | Iran | 586 | <12 months | Surgeon | 50% sleeve 50% Plastibell |
- | Sleeve: 1.95% Plastibell: 3.1%f |
Sleeve: 0% Plastibell 2.1% |
| Okafor [26] | Nigeria | 102 | Immediate post-partum | Experienced surgeon | Plastibell | 1 year | 0% | 0% |
| Okekeg [10] | Nigeria | 322 | 8 days-13 months | 55% Nurses 35% Doctors 9% Trad. |
- | 3 month | 9.3% | 1.0% |
| Osuigwe [27] | Nigeria | 141 | 7-9 days | 54% Doctors 44% Midwives 2% Trad. birth attendants |
68% Plastibell 31% freehand |
6 weeks | 13.5% Plastibell: 8% Freehand: 27.3% |
2.1% |
| Palit [28] | UK | 1129 | Mean age 11 weeks | Trained nurses under supervision of consultant urologists | Plastibell | 3 months | 5.5% | 0.1% |
| Pateld [29] | Canada | 100 | 3-5 days old | 98% Medical doctors 2% Traditional Providers |
51% Gomco 47% Plastibell 2% Ritual |
- | 15%h | 2% |
| Perlmutter [30] | USA | 51 | Neonatal | Obstetrician or resident | Gomco | Up to 2 hours | 0% | 0% |
| Rehman [31] | Pakistan | 200 | Infant | Surgeon | 50% freehand 50% bonecutter | 1 week | 16% | 0.5% |
a Cases of minor bleeding stopped with simple pressure or 'conservative management' and excessive foreskin/inadequate circumcision are not included
b Includes complications defined as 'serious' or 'severe' by authors, or with long-term or life-threatening sequalae (partial amputation of glans, urethral laceration, need for re-surgery or plastic surgery)
c 18 patients with yellowish patches of sloughed tissue and erythema who did not have an infection confirmed through cultures, 4 patients with irregular skin margin and 4 patients with inadequate skin excision were excluded
d In these studies patients who had undergone circumcision were identified retrospectively, but wherever possible patients were actively followed up to obtain accurate complication risks.
e Risks by age at circumcision: 7-14 days: 0.9%; 15 days - 2 months: 4.7%; 2 - 9 months: 11.5%
f Excludes 'excess mucosa' and 'delayed Plastibell falling off'
g Patients were identified through an immunization clinic and a physical examination was conducted to confirm circumcision status and the presence and type of complications. Uncircumcised boys were followed up to identify boys circumcised at a later age and any complications
h 31 cases of mild oozing, 7 cases of mild infection with no antibiotic treatment were excluded