Circumcision

Everyone in Israel knows what circumcision is – it is one of the most ancient Jewish ceremonies, in which the foreskin is removed from the tip of the penis when the newborn is eight days old (unless he is suffering from an illness requiring him to remain in hospital). Most parents choose a mohel to perform the circumcision, but today, this can also be done another way: as an operation in all respects, in hospital.

Surgical circumcision is, in fact, a procedure that urological surgeons have been performing already for many years at various hospitals. Nevertheless, the number of people who are aware that this option exists is relatively very small, and instead, the traditional method is chosen. Furthermore, there are religious decisions that claim that the way in which a surgical circumcision is performed in not ‘kosher’ in Jewish law – an additional reason that many avoid this option.

The big advantage of surgical circumcision is the possibility of circumcising the little baby without him feeling pain. In traditional circumcision, the procedure is performed with no anesthesia, whereas in hospital, it is performed under local anesthesia. Incidentally, surgical circumcision can be suitable not only for babies but also for children and adults who have not been circumcised for various reasons.

General information about the procedure

Surgical circumcision in newly born infants is performed, as stated above, under local anesthesia. In older children, who are aware of their environment, and sometimes also in adults, circumcision may be performed under general anesthesia, with local anesthesia added to prevent pain after waking up from the operation.

As a rule, surgical circumcision is performed today by two techniques – using the ‘Plastibell’ or using the ‘Gomco clamp’. In both methods, the aim is to completely remove the foreskin, without injuring the tip of the penis – the glans penis – as its future shape will be determined and shaped by the results of the operation.

Preparing for the procedure

As mentioned above, most circumcisions at a young age are performed under local anesthesia, which requires no special preparation. Essentially, just as is the case for a circumcision performed by a mohel, it is also the case for surgical circumcision that there is nothing that needs to be done in preparation for the procedure. If the procedure is performed under general anesthesia, it may be necessary to fast for a few hours before the beginning of the operation.

Course of action

After the decision regarding the appropriate type of anesthesia, the operation itself will begin. The method of the operation will be chosen in accordance with the surgeon’s experience.

If the ‘Plastibell’ method is used, a dome-shaped device will be placed on the tip of the penis. A tie will be made around the foreskin, and it will be cut with a nylon cord. A portion of the device will be detached, and a plastic ring will remain around the location of the cut for a few days, ensuring good closure of the injured tissues. If the ‘Gomco clamp’ method is used, the foreskin is drawn over the device, which also looks like a dome sitting on the tip of the penis. The physician will apply around the clamp to the point where the foreskin is attached to the glans, for five minutes, and when five minutes pass, will remove the foreskin using a surgical knife. With this method, the penis will be bandaged on completion of the procedure.

With both methods, the operation will take about half an hour at the most, and the patient will usually be discharged from the hospital already after a few hours…

Since the operated area is under anesthesia of one type or another, the patient shouldn’t feel any pain. During the first few days, there may be discharged from the operated area, but this discharge is considered to be ‘good’, indicating that the area is healing naturally.

A big advantage of performing a surgical circumcision is the ability of the physician, a urological surgeon by profession, to immediately address any problem or development that may occur during the operation, such as more intense bleeding than usual. If needed, in accordance with the diagnosis made before the operation, it is possible in the framework of the operation to also correct birth defects in the region of the glans penis, such as a low opening of the urethra.

side effects

Complications from surgical circumcision are considered to be rare. The area of the operation will naturally be swollen for a few days, but the swelling will resolve by itself. Pain could also continue for a few days. Bleeding or infection in the operated area occur rarely, as do injury to the shape of the glans penis, penile torsion or curvature. An additional rare side effect is excess skin being left, or the creation of a state of lack of skin in the operated area. All these can be treated relatively easily in the operating room.