Stapler or Shang ring—which circumcision device is more effective and safer? Among modern, minimally invasive methods, these two lead the field. The answer is provided by a meta-analysis—the highest level of scientific evidence—covering 12 studies and 3,345 patients, published in Revista Internacional de Andrología.
Methodology: 12 Studies, 3,345 Patients, Systematic Review
The authors searched PubMed, Embase, CNKI, and other databases, including randomized and prospective studies comparing the stapler with the Shang ring in the treatment of phimosis and redundant prepuce. Twelve studies were included (8 RCTs + 4 prospective): 1,661 patients in the stapler group and 1,684 in the Shang ring group. Risk of bias was assessed using the Cochrane tool.
Meta-analysis combines the results of multiple studies into a single pooled evidence base—which is why it stands at the top of the “evidence pyramid” and represents the strongest clinical argument.
Results: Stapler Wins in Nearly Everything
| Parameter | Stapler (DCSD) vs Shang Ring | Significance |
|---|---|---|
| Healing time | ~9 days shorter | p0.001 |
| Postoperative pain (24 h) | significantly lower | p0.001 |
| Satisfaction with appearance | 93% vs 83% | p=0.001 |
| Wound infection | ~84% lower risk (RR 0.16) | p0.001 |
| Wound edema | ~76% lower risk (RR 0.24) | p0.001 |
| Wound dehiscence | ~64% lower risk (RR 0.36) | p0.001 |
| Adverse events | ~58% lower risk (RR 0.42) | p0.001 |
| Procedure time | shorter | p=0.02 |
| Intraoperative bleeding | slightly higher | p=0.02 |
| Cost | higher | p0.001 |
Key Advantages: Healing and No Pain During Removal
- ~9 days shorter healing—because the stapler cuts and sutures the wound simultaneously, while the Shang ring remains on the penis and requires removal after ~7 days.
- No pain during suture removal—removing the Shang ring can be painful (sometimes requiring anesthesia), which the stapler does not involve.
Significantly Fewer Complications
The meta-analysis demonstrated significantly lower risk in the stapler group for wound infection, edema, wound dehiscence, and overall adverse event rate. The authors attribute this in part to the fact that the Shang ring, worn for 2–3 weeks, impairs lymphatic vessel regeneration and promotes edema and infection.
Where the Shang Ring Is Better—Honestly
- Intraoperative bleeding—slightly higher with the stapler (the ring physically compresses vessels before cutting). However, the difference was minimal.
- Cost—higher than the ring.
Limitations of the Meta-analysis
All included studies originated from China, some did not employ blinding, and there was significant heterogeneity among the studies. The authors emphasize the need for further high-quality, multicenter RCTs—however, sensitivity analysis confirmed the stability of the conclusions.
Anastomat ZSR 2.0 in Light of the Highest Evidence
Anastomat ZSR 2.0 belongs to the class of disposable staplers (DCSD), which in this meta-analysis proved more effective and safer than the Shang ring—with shorter healing, lower pain, better cosmetic outcome, and fewer complications.
View Anastomat ZSR 2.0 specifications → | Schedule a consultation →
Conclusions
The meta-analysis of 3,345 patients clearly indicates that the disposable stapler is a more effective and safer circumcision method than the Shang ring—primarily due to shorter healing, lower postoperative pain, better cosmetic outcome, and fewer complications.
Source: Huang C, Song P, Zhou S, et al. Disposable circumcision suture devices versus Shang ring circumcision for management of redundant prepuce or phimosis: A systematic review and meta-analysis. Rev Int Androl. 2017;15(3):108–118.
Content intended for medical professionals; does not replace individual clinical assessment.
Sources
- Huang C, Song P, Zhou S, Dai Y, Xu C, Gao Y, Zhao X. Disposable circumcision suture devices versus Shang ring circumcision for management of redundant prepuce or phimosis: a systematic review and meta-analysis. Rev Int Androl. 2017;15(3):108–118. doi:10.1016/j.androl.2017.03.003. View publication
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