Bawazir Osama A, Banaja Abdulaziz M
Department of Surgery, Faculty of medicine Umm Al-Qura University, Makkah& King Faisal Specialist Hospital & Research Centre, Saudi Arabia.
J Pediatr Urol. 2020 Aug;16(4):493.e1-493.e6. doi: 10.1016/j.jpurol.2020.06.025. Epub 2020 Jun 25.
and objective: Male circumcision is a common procedure all over the world; in Saudi Arabia, circumcision is the most frequent elective surgical procedure performed on males. The use of sutures for neonatal circumcision may decrease bleeding; however, it may lead to skin sinus formation. The objective of this study was to compare the sutureless to the interrupted sutures technique for neonatal circumcision with Gamco clamp.
We performed a randomized controlled clinical trial between 2017 and 2018. The study included 182 newborns assigned into two groups. Group 1 (n = 94) included neonates who had sutureless circumcision, and group 2 (n = 89) included neonates who underwent circumcision using interrupted absorbable 6/0 sutures. Study endpoints were bleeding, wound gaping, skin tunneling or sinus, and cyst formation.
There was no significant difference in patients' age and weight between groups. The procedure was significantly longer in group 2 (12.24 ± 2.17 vs. 6.54 ± 1.42 min; p < 0.001). There was no difference in bleeding between both groups (4 (4.26%) vs. 2 (2.27%) in groups 1 and 2, respectively, p = 0.683). Cyst formation was significantly reduced in group 1 (2 (2.13%) vs. 13 (14.77%); p = 0.002) and skin sinus formation increased in group 2 (14 (15.91%) vs. 0 in group 2 and 1, respectively; p < 0.001).
Circumcision can be performed with several techniques, and the superiority of one approach over the other is still debated. Many surgeons use interrupted sutures to oppose the skin edges, and in some reports, tissue glue was used for skin edges re-approximation with acceptable cosmetic results. In our study, the mean time taken for sutureless circumcision was about 7 min, and for the suture circumcision, it took around 11 min. In addition, the formation of a skin tunnel or sinuses rate was high despite the use of very thin sutures.
Male circumcision is a common and safe technique with minor and treatable complications. Risks of bleeding and sinus track formation are low with the sutureless method. The sutureless technique is recommended after Gamco circumcision as the standard technique for male circumcision in the newborn.
目的：男性包皮环切术在全球都是一种常见的手术；在沙特阿拉伯，包皮环切术是男性最常进行的择期外科手术。新生儿包皮环切术中使用缝线可能会减少出血；然而，这可能会导致皮肤窦道形成。本研究的目的是比较使用Gamco夹进行新生儿包皮环切术的无缝线技术与间断缝线技术。
我们在2017年至2018年期间进行了一项随机对照临床试验。该研究纳入了182名新生儿，分为两组。第1组（n = 94）包括接受无缝线包皮环切术的新生儿，第2组（n = 89）包括使用6/0可吸收间断缝线进行包皮环切术的新生儿。研究终点包括出血、伤口裂开、皮肤隧道或窦道以及囊肿形成。
两组患者的年龄和体重无显著差异。第2组手术时间明显更长（12.24 ± 2.17分钟 vs. 6.54 ± 1.42分钟；p < 0.001）。两组出血情况无差异（第1组4例（4.26%），第2组2例（2.27%），p = 0.683）。第1组囊肿形成明显减少（2例（2.13%） vs. 13例（14.77%）；p = 0.002），第2组皮肤窦道形成增加（第2组14例（15.91%），第1组0例；p < 0.001）。
包皮环切术可以采用多种技术进行，一种方法相对于另一种方法的优越性仍存在争议。许多外科医生使用间断缝线来对合皮肤边缘，在一些报告中，使用组织胶水对皮肤边缘进行重新对合，美容效果尚可。在我们的研究中，无缝线包皮环切术平均用时约7分钟，缝线包皮环切术用时约11分钟。此外，尽管使用了非常细的缝线，皮肤隧道或窦道形成率仍然很高。
男性包皮环切术是一种常见且安全的技术，并发症轻微且可治疗。无缝线方法出血和窦道形成的风险较低。建议在Gamco包皮环切术后采用无缝线技术作为新生儿男性包皮环切术的标准技术。
