Circumcision is a surgical procedure that involves the removal of the foreskin, the fold of skin covering the head (glans) of the penis.

Circumcision on newborns may be performed after 24 hours of birth. It is typically performed during the first few months of life of children.

• Patients are usually received in the preparation room by our nurses around 30 minutes prior to the procedure.
• They are checked by our nurses, correctly identified and an ID bracelet attached to their ankles.
• Parents are counselled regarding the Plastibell procedure, possible outcomes and complications with a thorough explanation of red flags and advice on when to seek urgent medical attention.
• Our surgeon will perform a physical examination of the baby to make sure that the baby is in good health to undergo the procedure and in the genital region there is no anatomic abnormalities.
• Parents are counselled again regarding the procedure and informed consent is obtained.

• A paracetamol suppository with a dose dependent on the weight is administered.
• The baby is then transferred to the procedure room and strapped to the Circumstraint.
• Time-out is performed to correctly identify the patient and the intended procedure.
• During the procedure the baby will be soothed and monitored by our nurse with the help of sucrose solution.
• The penis and surrounding skin are prepped with a Chlorhexidine sponge, and draped with a sterile slit drape.
• A dorsal penile block will be performed via infiltration of bupivacaine solution into the subcutaneous tissue of the suprapubic region, just proximal to the base of penis through 2 punctures blocking the dorsal penile nerves.
• The foreskin is then retracted using a hemostat, and adhesions are bluntly dissected completely exposing the whole corona and all smegma is cleared.
• The frenulum is divided using bipolar forceps along with diathermy to all bleeding points.
• An appropriately sized Plastibell is selected.
• The foreskin is then protracted over the glans. The free edge is then held by 2 hemostats in 2 and 10 o’clock positions. A dorsal slit is performed using another hemostat.
• The Plastibell is applied over the glans, hemostats holding the foreskin are raised and a third hemostat is applied transversely over the foreskin holding the Plastibell in place. The ligature is then tied in a secure manner over the foreskin onto the groove of the Plastibell, then the knot is secured by multiple throws. Excess foreskin is then cut and the Plastibell handle is detached.
• The inside of the Plastibell is then carefully cleaned from any blood or clots, making sure hemostasis is secured.
• Fucidin ointment is applied.

• Baby is then sent back to the preparation room and observed for 20 minutes. The Plastibell is then checked by our nurse making sure there is no active bleeding and that the baby has urinated normally.
• Baby will be discharged with aftercare instructions, paracetamol drops to be used when in pain and fucidin ointment to be applied topically until the Plastibell falls away.