Comparison of the efficacy of disposable circumcision suture, “commercial ring” circumcision and traditional circumcision
Abstract】Objective: To investigate the clinical efficacy of using disposable circumcision sutures compared with “commercial ring” circumcision and traditional circumcision. Methods: Patients with prepuce and circumcision were circumcised by disposable circumcision suture, “commercial ring” circumcision and traditional circumcision, and their preoperative, intraoperative and postoperative outcomes were compared. Results: Disposable circumcision suture circumcision was better than “commercial” circumcision and traditional circumcision in all aspects, except for the relatively higher price. Conclusion: Disposable circumcision suture circumcision is simple, minimally invasive, safe, aesthetic, automatic suture, and worth promoting.
During the period from May 2014 to May 2015, patients with prepuce and phimosis were circumcised by disposable circumcision suture (suture group), “commercial ring” circumcision (commercial ring group), and traditional circumcision (traditional group), and the preoperative, intraoperative, and postoperative comparisons of the three procedures revealed that disposable circumcision suture circumcision ( suturer group) is simple to operate, minimally invasive, safe, beautiful, and automatically sutured, and is reported as follows.
1. Information and methods
1.1 General information: 129 cases in this group, including 48 cases of circumcision and 81 cases of prepuce. Age 9-46 years old, average age 21 years old. The cases were randomly divided into two groups according to the “envelope method”: 43 cases in the suture group, including 12 cases of prepuce and 31 cases of prepuce; 43 cases in the commercial ring group, including 11 cases of prepuce and 32 cases of prepuce; 43 cases in the traditional group, including 15 cases of prepuce and 28 cases of prepuce.
1.2 Surgical methods
1.2.1 Pre-operative preparation: routine examination was performed before surgery to exclude some contraindications to surgery (such as endocrine and hematological system diseases). Preoperative routine skin preparation. For the suture device group, a disposable circumcision suture device of corresponding size was selected with a special measuring tool, consisting of a bell-shaped glans seat, a nail bin ring, a suture ring, a circular cutting knife, an adjustment knob, a safety clasp, and a striking handle. There are 5 models according to the size of the penis.
1.2.2 Surgical method: The patient is placed in supine position, the surgical field is disinfected with 1% iodine volt, a towel is laid, and anesthesia with 0.75% lidocaine for penile root nerve block is done, and surgery is performed after anesthesia takes effect. If the foreskin and the glans penis are adherent, first separate the adhesions, clean the foreskin, expose the glans coronalis and disinfect (1) suture group ① Clamp the ventral side of the foreskin (at the ligature) with hemostatic forceps at the inner and outer plate displacement, then clamp the other parts with four hemostatic forceps respectively in order to lift the foreskin. Note that the inner plate is appropriately tightened and the ligature is kept loose to ensure that the ligature is not excised too much. ②Select the appropriate suture type, turn out the adjustment knob and remove the bell-shaped glans seat. Lift the foreskin and place the bell-shaped glans holder into the foreskin with the bell holder over the glans. Hold against the ventral skin to prevent lifting and push the glans into the bell housing at the tether. ③Tilt the longitudinal axis of the bell-shaped glans seat at a certain angle to the longitudinal axis of the penis to keep the bell edge in the same direction as the coronal sulcus to ensure accurate positioning of the precut site. ④Fasten the foreskin to the puller with a tie. If the foreskin is too thick or too much, the excess foreskin must be removed outside the tie. ⑤ Insert the puller into the center hole of the circumcision suture, screw on and tighten the adjusting knob to the tail end surface of the puller, which is level with or slightly protrudes from the back of the adjusting knob. ⑥Remove the safety clasp, press the handgrip firmly with both hands and strike the circumcision suture, the foreskin is cut and sutured at the same time. (7) After 30 s, release the handgrip, turn out the adjustment knob, gently remove the instrument and the cut foreskin, a few not completely cut, trimmed with scissors, rare punctate active bleeding, to be sutured, external dry gauze and elastic bandage with appropriate pressure bandage, exposing the glans. (2) The commercial ring group adopts the appropriate type of commercial ring for circumcision, ① on the inner ring and pull the foreskin upward, so that the inner ring is completely set in, exposing the coronal sulcus, for the circumcision or difficult to flip the foreskin of the patient, need to perform dorsal circumcision, after the incision need to clamp the proximal end of the incision with vascular forceps to prevent tearing the inner plate when flipped. ②Superior external ring, moderate adjustment to retain the inner and outer plates of the foreskin in proportion, complete retention of the tether, and fastening of the external ring fixed buckle. ③ Excision of the foreskin. Use tissue scissors to cut off the excess foreskin along the union of the inner and outer rings. ④Make a reduction incision at 2, 5, 8 and 11 points on the edge of the foreskin to prevent the ring scab from narrowing. ⑤ Iodine volts were applied to the wound, and the wound was wrapped with sterile gauze and removed after 4 hours. (3) The conventional group was operated by the conventional surgical method with absorbable sutures to close the incision margins.
1.2.3 Postoperative treatment: Adults were given oral ethylene estradiol to prevent penile erection to avoid secondary bleeding. (1) Suture group: oral antibiotics for three days or no antibiotics, shower after one week, and disinfect the incision with 0.5% iodine volt after the shower. Thereafter, disinfect the surgical incision with iodophor twice a day or more, and do not overdo it in January. The suture staples begin to fall out one week after surgery, and most of them are removed within one month. In rare cases, the staples may be cut and removed by the physician. (2) Commercial ring group: take oral antibiotics for 3-5 days, and remove the ring 7-10 days after surgery. During this period, pay attention to keep the penis clean and wash it every day, preferably with iodine volt cotton balls after urination. Minimize the number of erections: take medication to control and drink less water before bedtime. (3) Traditional group: take oral antibiotics for 3-5 days after surgery, change medication for 2 days after surgery, disinfect with 0.5% iodine volt once a day after a week, absorbable threads start to fall off 20 days after surgery, about 1.5 months gradually finished.
2.Results
In this group, there was 1 case of infection in the traditional group and 2 cases of delayed healing after dressing change; 22 cases of incision infection in the commercial ring group, among which 6 cases of incision ring split, which healed after clearing and suturing, and 16 cases of delayed healing after dressing change; 1 case of suture staple did not fall off completely in January in the suture device group and was given to remove, and the rest healed in 1 phase . The preoperative, intraoperative and postoperative related factors of the three procedures were compared, and the results are shown in the table.
3.Discussion
Circumcision and prepuce are common malformations of male external genitalia. The chronic stimulation of foreskin scale and recurrent epithelial glansitis are often important factors to cause penile cancer, and early circumcision is of certain significance to prevent penile cancer. Therefore, the development and promotion of circumcision has become an important and recognized global health intervention strategy. At the same time, it can reduce the local sensitivity of the glans and is a simple and effective treatment for premature ejaculation symptom relief. Currently, more and more patients are seeking for circumcision, and patients’ requirements for the procedure have also increased, not only for reducing surgical complications, but also for the aesthetic appearance of the penis after surgery.
Circumcision is an ancient surgery, but the surgical method is constantly improving, the above three ways are more common at present, the analysis is as follows: (1) the traditional group of indications is wide, sutures are not applicable to those whose foreskin has acute inflammation, because their foreskin inner and outer plates are stimulated by acute inflammation, foreskin tissue edema, postoperative suture nail off, thus leading to postoperative bleeding. The commercial ring is likewise not applicable to those with acute inflammation of the foreskin, and the postoperative incision exudes much and increases the incision cracking rate. (2) The price of traditional group is relatively cheap, the price of commercial ring group is in the middle, and the suture is relatively expensive, which is acceptable to patients because of the improvement of economic level. (3) The suture device group has obvious advantages in operation time and less pain because excision and suturing are successful at once, and patients are happy to accept it because they do not need to endure the pain of ring removal and suture removal after operation; the operation time of the commercial ring group is also short, but it is very painful when removing the ring after operation, and although external local anesthetic cream is tried, the effect is limited and it affects the convenience of operation; the operation time of the traditional group is longer and patients are in pain. (4) The traditional group had obvious intraoperative bleeding and required electrocoagulation to stop bleeding; the sutures basically did not bleed, and there were suture staples to protect the incision after surgery, and none of the cases had incisional dehiscence; the commercial ring group also had little intraoperative bleeding, but the rate of incisional dehiscence and bleeding due to penile erection after ring removal was high. (5) In the traditional group, the pain and swelling were obvious, especially at the ligature and in children; in the suture group, the pain was mild mainly within 12 hours after the operation; in the commercial ring group, the pain was obvious 12 hours after the operation and during the removal of the ring.
Comparison of preoperative and intraoperative conditions of the three circumcision procedures
Indications
Cost
Operating time
Intraoperative bleeding
Suture group
Most circumcision, circumcision
Relatively high
3-5min
Basically no
Traditional group
All prepuce and circumcision
Low
30-40min
more
Commercial ring group
Mostly circumcised, circumcised
medium
3-8min
less
Comparison of postoperative conditions of three types of circumcision
Hematoma
pain
Swelling
Care
Time of stitching and stapling removal
Appearance
Traditional group
Easy to appear
Last about 3 days
noticeable
Need to return to hospital several times to change medication
20d-45d after surgery
General
Suture group
Rare
Within 12h postoperatively
Mild swelling of some inner plates
At home dressing change care
Completion of detachment within 30d
aesthetically pleasing
Commercial ring group
rare
12h after surgery and before and after removal of the ring
noticeable
Convenient before IUD removal, very troublesome after IUD removal
7 days manual IUD removal
General