- A circumcision was first performed on Abraham at age of 90 years!
- Several other references to circumcision exist in the Old Testament
- It is also depicted on several Egyptian tombs and murals
- At birth the prepuce is normally adherent to the glans penis
- Produces a physiologically non-retractile foreskin
- Only 4% of boys have retractile foreskin at birth
- By 5 years, 90% will have a retractile foreskin
- Only 1% of boys have a true phimosis
- Only 3% boys have recurrent balanitis
- Each year 21,000 circumcisions are performed in the United Kingdom
- In the UK, 4% of boys will have had a circumcision by the age of 15 years
- In Scandinavia, 2% of boys are circumcised
- Many operations are probably unnecessary
Indications
- Social and cultural
-
Phimosis
- Balanitis xerotica obliterans
- Lichen sclerosis
- Trauma
- Balanitis or posthitis
- Ballooning of foreskin
- Paraphimosis
Technique
- Free all adhesions
- Avoid excessive tension in order to preserve skin
- Avoid blind dissection of foreskin to avoid glans injury
- Use sutures or bipolar diathermy for haemostasis
- Avoid excessive skin sutures
Complications
- 1% need reoperation for bleeding or haematoma
- Ulceration or suppuration
- Urethral meatitis
"Then Zipporah took a flint and cut off the foreskin of her son." Exodus
4:25
"At the time the Lord said unto Joshua: make thee knives of flint, and circumcise the
children of Israel the second time. An Joshua made him knives of flint and circumcised the children of
Israel at Gibeath-ha-araloth." Joshua 5:2-3.
Bibliography
Rickwood A M K, Kenny S E,
Donnell S C. Towards evidence based circumcision of English
boys: survey of trends in practice.
Br Med J 2000; 321:
792-793.
Lermann S E, Liao J C. Neonatal circumcision. Paediatr Clin North Am 2001;
48: 1539-1557.
Williams N, Chell J, Kapila
L. Why are children referred for circumcision? Br Med J
1993; 306: 28.
Williams
N, Kapila L. Complications of circumcision. Br J Surg 1993;
80: 1231-1236 |
