Adult Circumcision - Glue technique (with fast dissolving sutures)
The Freehand Method of circumcision or sleeve resection is what is generally offered in the NHS for Adult Circumcisions. It involves excising the foreskin either freehand or using a clamp technique followed by bringing the edges of the inner and outer foreskin together with sutures (+/- glue).
- Fully regulated by the Care Quality Commission
A freehand technique
A freehand technique is used after careful marking of the skin to decide the best level of ‘cut’. In adult circumcision making a careful judgment about where to make this cut is of paramount importance – as removing too much foreskin can result in both short and long-term complications with the risk of wound dehiscence during the acute phase of healing and painful erections in the long- term and removing too little foreskin may leave the client unsatisfied with the possibility of needing a future revision operation. Meticulous haemostasis is achieved with bipolar diathermy to stop any bleeding.
The outer foreskin is then sutured to the inner foreskin using 3.0 Vicryl Rapide suture (fast dissolving) in a subcuticular interrupted fashion to ensure no suture is visible on the outside and hence reduces the possibility of unsightly scarring that can result from suture techniques. This method of closure also ensures there is less chance of stitch sinuses or tunnels forming (a common complication with adult circumcision when non-surgeons perform these, or poor techniques are used in closing the wound).
The procedure is then completed using surgical glue circumferentially around the wound followed by a dressing.
Due to the remarkable success of the Stapling device, we very rarely have to use this technique nowadays and reserve this technique for those who may be deemed unsuitable for the Stapling Device. These patients may have abnormal scarring from balanitis or may be overweight. In this subgroup of patients, the Freehand technique is safer.
Pro's of the Glue technique
- The oldest technique of all the techniques available
- One can argue that a more tailored look can be achieved
- Careful haemostasis can be achieved.
Con's of the Glue technique
- Greater surgical trauma, resulting in more swelling and bruising
- Greater risk of infection as a more prolonged surgical time is necessary to complete the procedure
- A poorly performed procedure can result in poor cosmesis from stitch marks and tunnels (our techniques ensure minimal chances of this happening)
Procedures for adults
Adult Stapling Device
The GOLD standard of Circumcision procedures. The Adult Stapling Device simplifies the operation, with a short operating time and less surgical trauma to the area. This is a very safe and easy application, leaving a tidy cut with minimal scarring. The staples used fall off on their own without the need of revisiting the surgery.
Glue Technique (with fast dissolving sutures)
The Freehand Method of circumcision or sleeve resection is what is generally offered in the NHS for Adult Circumcisions. It involves excising the foreskin either freehand or using a clamp technique followed by bringing the edges of the inner and outer foreskin together with sutures (+/- glue).
Adult Shangring
A single-use, disposable device that consists of two concentric plastic rings. Once applied it stays on for 1-2 weeks and then must be physically removed. It is not our 1st choice device for adult circumcisions. There are more disadvantages than advantages to this device and many patients who have used this device have said they would not recommend anyone using this device.