Plastibell

The Plastibell Circumcision Device is a clear plastic ring with a deep groove running circumferentially designed for circumcising infant males. The Plastibell is placed onto the head of the penis during a 10 minute elective minimally invasive surgical procedure, and the device will fall off within 3 to 7 days. The Plastibell was invented by Hollister Inc in 1950, and first reported on in 1953.cite journal
author = Miller, R.L.
coauthors = Snyder, D.C.
year = 1953
title = Immediate circumcision of the newborn male.
journal = Am J Obstet Gynecol
volume = 65
issue = 1
pages = 1-11
url = http://www.ncbi.nlm.nih.gov/pubmed/13016660
accessdate = 2008-07-16] cite journal
author = Kariher, D.H.
coauthors = Smith, T.W.
year = 1956
title = Immediate circumcision of the newborn.
journal = Obstet Gynecol
volume = 7
issue = 1
pages = 50-3
url = http://scholar.google.com/scholar?hl=en&lr=&ie=UTF-8&sa=G&oi=qs&q=immediate+circumcision+of+the+new+born+author:d-kariher
accessdate = 2008-07-16]

urgical Description

The Plastibell Circumcision Device is a clear plastic ring with handle designed for male neonatal circumcision that has a deep groove running circumferentially. The elective minimally invasive surgical procedure to install the Plastibell device may be performed by an OB/GYN, a pediatrician, a urologist, or a pediatric surgeon

The adhesions between glans and foreskin are divided with a probe. Then the foreskin is cut longitudinally to allow it to be retracted and the glans (the head of penis) to be exposed. The Plastibell comes in 6 sizes. The appropriate one is chosen and applied to the head (the circumcision pictured at right is in this stage). The ring is then covered over by the foreskin. A ligature is tied firmly around the foreskin, crushing the skin against the groove in the Plastibell. Then the excess skin protruding beyond the ring is trimmed off. Finally, the handle is broken off at the end of the procedure. The entire procedure takes five to ten minutes, depending on the experience and skill of the surgeon. [cite journal
last = Herbert
first = Barrie
coauthors = "et al"
title = The Plastibell Technique for Circumcison
journal = Br Med J
volume = 2
issue = 5456
pages = 273–275
date = 1965
url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1845746] As with all circumcisions, the procedure should involve adequate anaesthesia, using either EMLA cream, [Russell, T: Topical anaesthesia in neonatal circumcision: a study of 208 consecutive cases. Aust Fam Physician Jan 1996:S30-4] dorsal penile nerve block, penile ring block, or a combination of these prior to operation. The ring falls off in 3 to 7 days leaving a circumferential wound that will heal over the following week. Typically, the glans will appear red or yellow until it has cornified.

Advantages

The glans is protected during the procedure by the ring. Haemostasis (control of bleeding) is effective due to the ligature tie. Cosmetically, a predictable result is obtained due to the straight line of the ligature that causes the wound. It is a quick procedure once mastered - taking a few minutes to perform, and hopefully causing minimal discomfort for the baby.

No bandage is required, allowing easy monitoring for infection.

Healing occurs while the edges of the prepuce are secured in the ring, making skin bridges (where the foreskin's end heals to the glans' corona) unlikely.

Cosmetically, there will be little to no circumcision scar, though as usual with any circumcision, there will be a color change where the (formerly) inner and outer layers of foreskin meet.

Disadvantages

The ring must fall off before final healing can occur. Rarely, the tip of the glans may protrude through the ring and become swollen, trapping the ring in place. Blood transfusion risk 1 in 30,000 procedures (Wiswell).

Furthermore, because convalescence depends on a (temporarily) affixed medical device, risks of infection or hemorrhage due to the bell slipping or otherwise failing are greater [cite news
first = Mark
last = Brennae
title = Ontario boy dies after complications from circumcision
url = http://www.canada.com/vancouversun/story.html?id=cb3b8281-4134-46ba-85d3-b076072bda75&k=25810
work = The Vancouver Sun
publisher = CanWest News Service
date = June 13, 2007
accessdate = 2008-07-16] than a Gomco clamp or similar entirely-supervised circumcision.There are several reports in the medical literature of urinary retention after circumcision with the Plastibell device. [ [http://www.cmaj.ca/cgi/content/full/169/3/216 Acute venous stasis and swelling of the lower abdomen and extremities in an infant after circumcision - Ly and Sankaran 169 (3): 216 - Canadian Medical Association Journal ] ] One case resulted in death. [ [http://www.pulsus.com/Paeds/12_04/Pdf/zwol_ed.pdf Paediatrics & Child Health, Home ] ]

There also is a report of impetigo caused by Staphylococcus aureus when using the Plastibell. [ [http://www.cirp.org/library/complications/stranko1/ Impetigo in Newborn Male Infants Associated with a Plastic Bell Circumcision ] ]

Prevalence

At least 50% of American non-therapeutic infant circumcisions since 1980 have been performed with a Plastibell.

Notes and references

ee also

*Circumcision
*Gomco clamp

External links

*http://www.circlist.com/instrstechs/plastibell.html