Circumcision in children using a stapler is sometimes considered in the treatment of phimosis and recurrent inflammation of the foreskin. A randomized clinical trial published in Urology compared modified circumcision using a disposable stapler (DCSD) with the classic dorsal slit method in 284 boys operated on for medical indications.
Methodology: 284 Children, Medical Indications, Randomization
The study included boys aged 7–16 years (mean 9.7) operated on between 2017–2018 for medical indications: phimosis, recurrent balanitis and posthitis, redundant foreskin. Patients were randomly assigned to:
- stapler group (DCSD, modified) — n=144,
- classic group (dorsal slit, electrocoagulation, absorbable suture) — n=140.
The study obtained bioethics committee approval and written consent from parents/guardians. All procedures were performed by two experienced urologists under local anesthesia.
Results: Faster, Less Pain, Fewer Complications
| Parameter | Stapler (DCSD) | Classic Method | Significance |
|---|---|---|---|
| Procedure time | 7.4 min | 21.3 min | p0.001 |
| Blood Loss | 2.6 ml | 5.6 ml | p0.001 |
| Intraoperative Pain (VAS) | 2,4 | 6,4 | p0.001 |
| Postoperative Pain 24 h (VAS) | 1,8 | 3,4 | p0.001 |
| Healing time | 12.2 days | 14.2 days | p0.001 |
| Complications | 4,3% | 12,3% | p0.05 |
| Severe Edema | 0,7% | 5,8% | p0.05 |
| Cosmetic Satisfaction | 99,3% | 92,8% | p0.05 |
The complication rate decreased nearly threefold (4.3% vs 12.3%), and severe edema occurred in only 0.7% of children in the stapler group.
Key Modification: Marking the Incision Line
The authors combined the advantages of both methods: before using the stapler, they marked the incision line with a suture at the “6” and “12” o’clock positions, 0.5–1.0 cm from the coronal sulcus. This allowed the device to make an even, symmetrical cut and eliminated the risk of removing too much or too little skin.
Higher Satisfaction and Faster Healing
Satisfaction with the cosmetic outcome was reported by 99.3% of families in the stapler group compared to 92.8% in the classic method. The authors attribute the shorter healing time to less damage to the superficial fascia of the penis and better blood supply.
Limitations – Honestly
The cost of the stapler procedure was higher. The study included older children (7–16 years), without newborns and infants — the authors indicate the need for larger, multicenter studies. Proper selection of device size is crucial for safety.
Anastomat ZSR 2.0 in the Context of Pediatric Patients
Anastomat ZSR 2.0 belongs to the class of disposable circumcision staplers evaluated in this study and is available in a wide range of sizes — which is significant for procedures in younger patients for medical indications.
Learn about the sizes and specifications of Anastomat ZSR 2.0 → | Schedule a consultation →
Conclusions
In a randomized study of 284 children operated on for medical indications, modified circumcision using a disposable stapler was simpler, faster, less painful, and associated with a lower risk of complications than the classic method, with higher satisfaction with the cosmetic outcome.
Source: Rao JM, Huang H, Chen T, et al. Modified Circumcision Using the Disposable Circumcision Suture Device in Children: A Randomized Controlled Trial. Urology. 2020;143:206–211.
Content intended for medical professionals; concerns procedures performed for medical indications by qualified specialists. Does not replace individual clinical assessment.
Sources
- Rao JM, Huang H, Chen T, Yang CG, Pan CZ, Deng GC, Shen LJ, Qian XH, Peng MK, Zhou HD, Peng HL. Modified circumcision using the disposable circumcision suture device in children: a randomized controlled trial. Urology. 2020;143:206–211. doi:10.1016/j.urology.2020.06.018. PMID: 32593627. View in PubMed
Leave a Reply