Dorsal versus Lateral Knot Placement in Plastibell Circumcision: a comparative study
Dorsal versus Lateral Knot Placement in Plastibell Circumcision
DOI:
https://doi.org/10.52442/jrmi.v12i2.1039Keywords:
Bleeding, Male Circumcision, Plastibell, Postoperative Complications, Surgical Wound Infection, Treatment OutcomeAbstract
Introduction: The Plastibell device is a popular method for infant circumcision. While technical factors like device sizing are known to affect outcomes, the influence of ligature knot position has not been rigorously investigated.
Objective: To compare postoperative complication rates between dorsal (over the superficial dorsal vein) and lateral knot placement in Plastibell circumcision.
Materials and Methods: This non-randomized, parallel group comparative study was conducted from April 8, 2024, to April 7, 2025, involving 231 infants under one year of age. Participants were allocated into two groups: Group A (Dorsal knot, n=109) and Group B (Lateral knot, n=122). Both groups were followed for complications including bleeding, infection, ring slippage/impaction, and time to Plastibell separation. The primary outcome was time to Plastibell separation. Statistical analysis was performed using Chi-square and Mann-Whitney U tests.
Results: The groups were comparable in baseline characteristics. No statistically significant differences were found in the rates of bleeding (Group A: 1.8% vs. Group B: 4.1%, p=0.316), infection (6.4% vs. 3.3%, p=0.263), or ring slippage (2.8% vs. 5.7%, p=0.266). However, delayed ring separation (>7 days) was significantly more frequent in Group A (10.1%) compared to Group B (2.5%) (p=0.032). The mean difference in separation time was 0.73 days (95% CI: 0.17–1.29).
Conclusion: Lateral knot placement during Plastibell circumcision is associated with a statistically significant and clinically relevant reduction in the time to ring separation, without increasing the risk of other complications. This simple technical modification promotes faster ring separation, potentially reducing caregiver anxiety and improving postoperative satisfaction.
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