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NO INSTRUMENTS, NO SUTURES, NO WORRIES: CIRCUMCISION USING 2-OCTYL CYANOACRYLATE IS SAFE AND EFFECTIVE IN A COHORT OF 634 POST-NEONATAL PREPUBESCENT BOYS
Jennifer M. Lovin, M.D..1, Kathryn M. Stone, B.S.2, Josie K. Pickett, B.S.2, Andrew J. Kirsch, M.D.1.
1Children's Healthcare of Atlanta, Atlanta, GA, USA, 2The University of Georgia, Athens, GA, USA.

BACKGROUND: Circumcision is the most commonly performed surgical procedure in the world, with one-third of males circumcised globally. Post-neonatal, prepubescent sutured circumcision demonstrates complication rates ranging from 1.7% - 9.1%. We have previously reported that 2-octyl cyanoacrylate (2-OCA, Dermabond, Ethicon) primary circumcision (PC) and circumcision revision (CR) in prepubescent children demonstrated superior cosmesis, shorter operating room (OR) times and cost savings. The aim of our study is to evaluate short term complication and reoperation rates with a scalpel-free and suture-less technique for PC and CR using 2-OCA.
METHODS: Following IRB approval, we conducted a retrospective review of all boys at our institution who underwent PC or CR using 2-OCA between January 2014 and January 2021. All procedures were performed by a single surgeon. The technique included 1) a circumferential inner incision using electrocautery (cutting current), 2) a circumferential outer incision using electrocautery (coagulation current), 3) foreskin removal, 4) meticulous hemostasis, 5) skin edge alignment by upward displacement of penile shaft skin to appose distal mucosal collar, 6) application of thin layers of 2-OCA, 7) antibiotic ointment application. No aligning sutures or instruments were used in this process. Patients that required sutures or compressive dressings based on age or associated anomalies were excluded from analysis. Thirty day return to system and 48-hour return to OR data were obtained using the REDCap database.
RESULTS: A total of 634 procedures (479 PC and 155 CR) were performed during the study period. Median age was 12 months (range 3 months - 10.4 years). There were 5 patients (0.79%) that returned to system within 30 days. Of these, 4 patients were treated non-operatively (2 surgical site bleeding, 1 urinary tract infection, 1 viral illness). Only one patient (0.15%) required surgical intervention within 48 hours and none required surgical intervention by 30 days. A total of 3 (0.47%) post-surgical complications were deemed related to surgery, 2 Clavien-Dindo I complications and 1 Clavien-Dindo IIIB complication.
CONCLUSIONS: Our technique for suture-less circumcision using 2-OCA offers superior cosmesis, shorter OR times, cost savings, and a substantially lower complication rate (0.47%) compared to sutured circumcision (>1.7%) reported in post-neonatal prepubescent boys.


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