Neonatal circumcision with local anesthesia. Results of a standardized protocol

Abstract

Introduction: Neonatal circumcision is a common procedure in the US and other countries, with low rates of complications in trained hands. However, it has recently been incorporated into the clinical environment in Chile. Our goal was to establish a local standardised protocol for neonatal circumcision under local anaesthesia, and evaluate the results and possible complications.

Patients and Method: A standardised prospective protocol was used on patients who underwent neonatal circumcision. The inclusion criteria were: children < 60 days and < 5 kg. The surgical technique used was topical local anaesthesia and penile block, attrition of redundant prepuce and mucosa with Mogen® clamp, and section with scalpel. The protocol was used and evaluated from November 2005 to October 2014 by a paediatric surgeon and/or paediatric urologist trained in the technique. Complications and conditions until final discharge were analysed.

Results: The protocol was applied to 108 patients over a 9 year period. The mean age at procedure was 9 days (1-52). One patient (0.9%) had immediate bleeding, requiring further surgery. All patients were discharged from further medical checks at 1 month, without any other complications. The reason for the procedure was by parental request in 100% of the cases, and always for sociocultural reasons.

Conclusion: Neonatal circumcision under local anaesthesia is a simple procedure, and has excellent results in selected patients, and with no major complications. With proper training, and adapting the initial protocol, it can be performed on an outpatient basis, without putting the neonates through the risks of general anaesthesia.