Van Haute C, Tailly T, Klockaerts K, Ringoir Y
AZ St Lucas, Department of Urology, Groenebriel 1, 9000 Ghent, Belgium.
J Pediatr Urol. 2015 Jun;11(3):147.e1-5. doi: 10.1016/j.jpurol.2015.02.013. Epub 2015 Mar 20.
Circumcision is the most common surgical procedure in male children in the world and is performed because of cultural, religious or medical reasons. Traditionally, interrupted sutures are used to close the wound, but 2-Octyl cyanoacrylate (2-OCA) tissue glue can be used as an alternative method to close the circumcision wound.
To compare the use of 2-OCA with absorbable sutures in circumcision wound closure in prepubescent patients in terms of operative time, complication rate, postoperative pain and cosmetic results.
We retrospectively evaluated 662 circumcision procedures using sutures and 609 procedures using 2-OCA for wound closure in prepubescent boys. All circumcision procedures were performed by 2 surgeons in a single centre. Operative time was collected from the hospital surgical software system. 62% of the patients in the suture group and 59% of the patients in the 2-OCA group presented for a postoperative check-up 6 weeks after the circumcision. Data regarding postoperative pain, need for analgesia, cosmetic satisfaction and the ease of wound care were collected through questionnaires completed by 25% of the boy's parents in the suture group and 53% of the parents in the 2-OCA group.
Mean operative time was significantly shorter in the 2-OCA group (13 min) than in the suture group (17 min). Complications were comparable and mostly minor. Reintervention was only required in 3 cases. According to the parents, the degree of postoperative pain and the postoperative need for analgesics was significantly lower in the 2-OCA group. Wounds closed with 2-OCA were easier to care for. The cosmetic results after 1 day, after 1 week and after 1 month in the 2-OCA group were significantly superior than in the suture group, according to the parents' evaluation.
The use of 2-OCA in circumcision wound closure has been reported before. Previous studies with mainly limited patient numbers report less pain, shorter procedure times and a higher surgeon satisfaction in terms of cosmetic results. This study is the largest study comparing the use of 2-OCA and interrupted sutures in circumcision wound closure. The retrospective character of the study, the lack of a validated questionnaire tool for the cosmetic evaluation and the use of the parent's evaluation are the limitations of this study.
The use of 2-OCA in circumcision wound closure results in a shorter operative time, in less postoperative pain, in easy postoperative wound care and in excellent cosmesis when compared to interrupted absorbable sutures. 2-OCA is our current technique of choice in circumcision wound closure.
包皮环切术是世界上男童最常见的外科手术，其实施是出于文化、宗教或医学原因。传统上，使用间断缝合来闭合伤口，但2-氰基丙烯酸辛酯（2-OCA）组织胶水可作为闭合包皮环切伤口的替代方法。
比较在青春期前患者的包皮环切伤口闭合中，使用2-OCA与可吸收缝线在手术时间、并发症发生率、术后疼痛和美容效果方面的差异。
我们回顾性评估了662例使用缝线闭合伤口的包皮环切手术和609例使用2-OCA闭合伤口的青春期前男孩的包皮环切手术。所有包皮环切手术均由2名外科医生在单一中心进行。手术时间从医院手术软件系统中收集。缝线组62%的患者和2-OCA组59%的患者在包皮环切术后6周进行了术后检查。通过缝线组25%男孩的父母和2-OCA组53%的父母填写的问卷，收集了有关术后疼痛、镇痛需求、美容满意度和伤口护理难易程度的数据。
2-OCA组的平均手术时间（13分钟）明显短于缝线组（17分钟）。并发症相当，且大多为轻微并发症。仅3例需要再次干预。根据父母的反馈，2-OCA组的术后疼痛程度和术后镇痛需求明显更低。用2-OCA闭合的伤口更易于护理。根据父母的评估，2-OCA组在术后1天、1周和1个月时的美容效果明显优于缝线组。
此前已有关于在包皮环切伤口闭合中使用2-OCA的报道。以往研究主要因患者数量有限，报告显示疼痛较轻、手术时间较短且外科医生对美容效果的满意度较高。本研究是比较在包皮环切伤口闭合中使用2-OCA和间断缝线的最大规模研究。本研究的局限性在于其回顾性特点、缺乏用于美容评估的经过验证问卷工具以及采用父母的评估。
与间断可吸收缝线相比，在包皮环切伤口闭合中使用2-OCA可缩短手术时间、减轻术后疼痛、便于术后伤口护理且美容效果极佳。2-OCA是我们目前包皮环切伤口闭合的首选技术。
