SIDEK CLINIC FOR WOMEN PTE LTD
Circumcision can be done safely under local anaesthesia using a plastibell device for newborns and babies below 4 months old.
Circumcision can be done safely under local anaesthesia using a plastibell device for newborns and babies below 4 months old. Unless there is an underlying medical reason, we would advise against doing the procedure on babies who are already able to turn on their tummies , as it may hinder good wound recovery. You would have to wait until the child is older.
Local anaesthesia is infiltrated at the base of the penis .Once the anaesthesia takes effect we will begin the surgery. Do not worry if your baby starts crying because even after anaesthesia we find that the babies still cry. Initially we will cut a piece of skin and expose the head of the penis.
The correct size of the plastibell device is placed around the head of the penis. Choosing the correct size of the plastibell is crucial to ensure a well done circumcision. We have all sizes of the plastibell device and we do fittings to ensure the correct size before we cut the excess skin.
Once the plastibell device is in place a string ligature is put around it. This will cut the excess skin by strangulation. The plastibell ring and string will drop off in a couple of days usually within a week. Once the device drops off the two cut edges of skin will heal by secondary union. There is no need to put any stitches and the wound will heal well.
The most common risk is bleeding especially at the posterior surface. We will ensure there is no bleeding at the end of surgery but sometimes, though rarely, bleeding may start a couple of hours later. If there is any bleeding which appears excessive , please contact the clinic or the doctor .
You may apply direct but gentle pressure to the area with clean cloth or swab for about 5 to 10 minutes.
The other risk is that too little foreskin is removed needing another surgery when the baby grows into a child. This is rare but may happen when the penis of the baby is buried in a layer of fat in a plump baby.
We can perform circumcision under local anaesthesia for a child from 5 years old onwards. From our experience, children under 5 years old are not mature enough and will not cooperate during the surgery.
Circumcision for children are usually performed during the school holidays with June , November and December being very busy months. Due to limited slots available during the busy months , do book early so your child can get the slot that you want. Medisave can also be used. The surgery is normally performed in the clinic under local anesthesia and the child would be fully awake . You have the option of doing the procedure under general anesthesia if you decide to do so . This has to done in a hospital setting or in a day surgery center .
Preparation begins before the surgery when local anaesthetic cream is applied at the base of the penis and around the head of the penis. We begin the surgery by infiltrating the area around the penis with local anaesthetic using a very fine needle. Despite applying the local anaesthetic cream, some children may still feel the sting of the needle. Once the anaesthesia takes effect, which is within 2 minutes, the child should not feel any pain but he may feel some sensation when he is touched. He may also feel some but manageable heat of the laser.
A Laser is then used to cut and trim the excess foreskin. We use the laser because there is very minimal bleeding and less tissue trauma. This generally will translate into faster healing times than conventional surgery. Once the cut edges are trimmed we will stitch the cut edges together with vicryl rapid which is an absorbable suture, which means there is no need to remove the stitches as it will drop off by itself.
After the procedure we will see the child a week later to see his progress. The stitches will start to drop off after two weeks of the procedure and in some cases may take a month to drop off. Full healing takes about two weeks but the child will normally be able to move around actively after 3 days of the surgery.
For children who are not cooperative or with various degrees of autism spectrum disorder, we would suggest operating on the child under general anesthesia . This however has to be done in the hospital or in a day surgery center . We will then be able to perform the surgery under ideal circumstances .
The most common risk is bleeding. Although the child normally goes home with no bleeding, there is a possibility of bleeding after 24 hours. If you encounter bleeding , apply pressure to the bleeding point using a swab or cotton wool for about 20 minutes. If the bleeding persists contact the clinic so we can advise you accordingly .
Obese children pose a special risk. This is because a significant part of their penis is buried in fat and after the procedure the penis may still not protrude from the abdomen thus appearing as though the child has not been circumcised .
Pain is subjective and some children may not be suitable for local anaesthesia. In such cases we will consult with the parents whether to proceed or to have the procedure done under general anaesthesia in a hospital. Please understand that the patient is only a child and may be not be able to fully comprehend the process he is going through. Sometimes it is the element of fear rather than pain that overwhelmed them. So we seek your understanding in this matter.
We are seeing more adults requesting for the procedure for hygiene or medical reasons. Adults have the option of seeing the doctor first and proceeding with the procedure on the same day or another day.
The procedure is the same as for the children but we would require that the patient shaves around the genital area completely before the procedure. The local anaesthetic we use is Marcaine and which lasts for about 4 hours . This is longer lasting than lignocaine, the anaesthetic we use for children .
You may have read on the internet on the different variations of circumcision , for example whether to remove the frenulum ,how much skin to remove and whether it be a high or low circumcision. Feel free to discuss with the doctor if you have any preferences or if you prefer to let the doctor decide on what is best for you.
We do not do dorsal slit with non excision of skin as we feel that this does not serve any purpose.
Adults have a longer recovery period because they would want to be able to perform intercourse. We would advise that you refrain from sexual intercourse for at least 6 weeks . This is to ensure that the wound have completely healed and there are no raw edges.
Engaging in sex before the wound has fully healed can result in infection and transmission of disease. Besides this, there is a risk of bleeding as in any form of surgery. If you start bleeding post surgery, apply pressure to the affected part and call the clinic as soon as possible