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Table 1 Prospective studies of frequency of complications in studies of neonatal and infant circumcision

From: Complications of circumcision in male neonates, infants and children: a systematic review

Author Country No. of patients Age Type of provider Method Follow-up period Frequency of adverse eventsa Frequency of serious adverse eventsb
Al Samarrai [11] Saudi Arabia 2000 2-3 days Junior staff with supervision Plastibell 6 weeks plus immunisation clinic visits 1.4%c 0%
Amird [21] Saudi Arabia 1000 Mean 9 days Surgeon Gomco clamp 1 year 1.6% 0%
Banieghbal[32] South Africa 583 Neonatal Surgeon Gomco clamp 1 month 0.3% 0%
Ben Chaim [9] Israel 19,478 Mean 8 days 83% Mohel
17% Physician
Freehand - 0.1% 0.1%
Bhat [22] Oman 250 Neonatal
(min 1 day)
Paediatrician Plastibell - 0% 0%
Duncan [23] Jamaica 205 Neonatal Surgeon Plastibell 1 week 1.5% 0%
Horowitz [24] USA 130 98 neonatal
32 infants (3-8.5 months)
Pediatric urologist Gomco clamp 3 days Overall: 7.4%
Neonatal: 0%
Infants: 30%
0%
Manji [25] Tanzania 368 7 days to 9 months Pediatrician Plastibell - 2.8%e 0%
Mousavi [33] Iran 586 <12 months Surgeon 50% sleeve
50% Plastibell
- Sleeve: 1.95%
Plastibell: 3.1%f
Sleeve: 0%
Plastibell 2.1%
Okafor [26] Nigeria 102 Immediate post-partum Experienced surgeon Plastibell 1 year 0% 0%
Okekeg [10] Nigeria 322 8 days-13 months 55% Nurses
35% Doctors
9% Trad.
- 3 month 9.3% 1.0%
Osuigwe [27] Nigeria 141 7-9 days 54% Doctors
44% Midwives
2% Trad. birth attendants
68% Plastibell
31% freehand
6 weeks 13.5%
Plastibell: 8%
Freehand: 27.3%
2.1%
Palit [28] UK 1129 Mean age 11 weeks Trained nurses under supervision of consultant urologists Plastibell 3 months 5.5% 0.1%
Pateld [29] Canada 100 3-5 days old 98% Medical doctors
2% Traditional Providers
51% Gomco
47% Plastibell
2% Ritual
- 15%h 2%
Perlmutter [30] USA 51 Neonatal Obstetrician or resident Gomco Up to 2 hours 0% 0%
Rehman [31] Pakistan 200 Infant Surgeon 50% freehand 50% bonecutter 1 week 16% 0.5%
  1. a Cases of minor bleeding stopped with simple pressure or 'conservative management' and excessive foreskin/inadequate circumcision are not included
  2. b Includes complications defined as 'serious' or 'severe' by authors, or with long-term or life-threatening sequalae (partial amputation of glans, urethral laceration, need for re-surgery or plastic surgery)
  3. c 18 patients with yellowish patches of sloughed tissue and erythema who did not have an infection confirmed through cultures, 4 patients with irregular skin margin and 4 patients with inadequate skin excision were excluded
  4. d In these studies patients who had undergone circumcision were identified retrospectively, but wherever possible patients were actively followed up to obtain accurate complication risks.
  5. e Risks by age at circumcision: 7-14 days: 0.9%; 15 days - 2 months: 4.7%; 2 - 9 months: 11.5%
  6. f Excludes 'excess mucosa' and 'delayed Plastibell falling off'
  7. g Patients were identified through an immunization clinic and a physical examination was conducted to confirm circumcision status and the presence and type of complications. Uncircumcised boys were followed up to identify boys circumcised at a later age and any complications
  8. h 31 cases of mild oozing, 7 cases of mild infection with no antibiotic treatment were excluded