Muhammad Sajjad Ashraf, Muhammad Shahab Athar, Yaqoot Jahan, Muhammad Talat Mehmood.
Bleeding following circumcision with plastibel: technical factors and prevention.
Pak J Surg Jan ;30(2):163-6.

Background: Plastibel is commonly used all over the world for circumcision because of ease and fewer complications. Bleeding is one of the complications that may be serious. We performed this study to fi nd out the cause of bleeding aft er plastibel circumcision in cases without bleeding disorder. Methodology: Th is study was carried out from October 2010 to March 2013 at Civil Hospital, Karachi and other hospitals of Karachi where all children referred to pediatric surgeon for bleeding aft er circumcision with Plastibel were studied. Th eir data was collected Plastibel removed source of bleeding identifi ed, bleeding controlled with bipolar diathermy and wound sutured. Results: In this study 73 children with age varied from 6 days to 28 months were included. 53.4% circumcisions were performed by pediatrician, followed by general practitioner, nondoctor and surgeon 34.2%, 6.8% & 5.5% respectively. Most of the procedures (50.6%) were carried out in clinics. Dorsal mucosal tear was found to be the most common cause of bleeding in (56.2%), followed by loose tie of plastibel thread (38.4%) and frenular tear (5.5%). Conclusion: Th e two major cause of bleeding following circumcision with plastibel are dorsal mucosal tear and loose tie of Plastibel thread and both of them are preventable. Bleeding form dorsal mucosal tear can be prevented by application of mosquito artery forceps at the apex of dorsal slit made during the insertion of Plastibel. Similarly loose tie can be prevented by application of proper surgeon’s knot; this prevents loosening of tie while second twist is being applied.

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