Plastibell

From Wikipedia, the free encyclopedia

The Plastibell Circumcision Device, invented by Hollister in 1950^{[citation needed]}, is a clear plastic ring with handle designed for circumcision. The ring has a deep groove running circumferentially.

As with all circumcisions, the procedure should involve adequate anaesthesia, using either EMLA cream, dorsal penile nerve block, penile ring block, or a combination of these prior to operation.

The adhesions between glans and foreskin are divided with a probe. Then the foreskin is cut longitudinally to allow it to be retracted and the glans (the head of penis) to be exposed. The Plastibell comes in 6 sizes. The appropriate one is chosen and applied to the head (the circumcision pictured at right is in this stage). The ring is then covered over by the foreskin. A ligature is tied firmly around the foreskin, crushing the skin against the groove in the Plastibell. Then the excess skin protruding beyond the ring is trimmed off. Finally, the handle is broken off at the end of the procedure. The entire procedure takes five to ten minutes, depending on the experience and skill of the surgeon.

The ring falls off in 3 to 7 days leaving a circumferential wound that will heal over the following week. Typically, the glans will appear red or yellow until it has acclimatized to its new surroundings.

[edit] Advantages of the Plastibell

The glans is protected during the procedure by the ring. Haemostasis (control of bleeding) is effective due to the ligature tie. Cosmetically, a predictable result is obtained due to the straight line of the ligature that causes the wound. It is a quick procedure once mastered - taking a few minutes to perform, and hopefully causing minimal discomfort for the baby.

Cosmetically, there will be little to no circumcision scar, though as usual with any circumcision, there will be a color change where the (formerly) inner and outer layers of foreskin meet.

[edit] Disadvantages of the Plastibell

The ring must fall off before final healing can occur. Rarely, the tip of the glans may protrude through the ring and become swollen, trapping the ring in place. Blood transfusion risk 1 in 30,000 procedures (Wiswell).

Furthermore, because convalescence depends on a (temporarily) affixed medical device, risks of infection or hemorrhage due to the bell slipping or otherwise failing are greater than a Gomco clamp or similar entirely-supervised circumcision.

[edit] Prevalence

At least 50% of American routine infant circumcisions since 1980 have been performed with a Plastibell.