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How to manage post-operative bleeding after Plastibell (ring) Circumcision

Introduction


Plastibell circumcision (ring method) is now a very common and popular circumcision method for babies and toddlers. It is a relatively easy method for new doctors to use when learning circumcision. Complications are rare with Plastibell circumcision but one of the common complications is post-operative bleeding. This usually happens within the first 24 hours after circumcision and occurs due to frictions or trauma against the penis. This usually causes a tear in the frenulum area due to the movement of the ring which leads to bleeding.


Potential problems


As with any bleeding, you normally would want to put some compression to control it. However, the Plastibell ring prevents us from applying direct pressure to the site of the bleeding in the conventional way. This meant that we needed to give local anaesthetic again, cut the thread which is holding the ring and then remove the ring. The foreskin would then need to be cut freehand and the bleeding controlled with pressure or cauterisation +/- suturing. This is lengthy procedure which is stressful for the parents who are already worried as their son had bleeding.


The new way of achieving haemostasis


We have come up with a new and very simple solution to achieve haemostasis very quickly. After removing any blood clots and identifying the bleeding source, then a small piece of gauze covered in Vaseline is placed directly between the glans and the ring. If the bleeding source is the frenulum, then the gauze is placed ventrally at the 6 o’clock position. You can use any fine instrument to help in pushing the gauze down into the corona. Usually, haemostasis is achieved immediately. The wound is reviewed after 10 minutes and if there is no further bleeding, then the patient can be taken back home. Please note if the patient has lost a lot of blood or appears pale, they should be referred to A&E for further management.


If you would like more information or you are a healthcare professional looking to get trained in circumcision and learn how to manage these complications, then please contact us on 0208 951 3794.

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