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Overview of Circumcision

1. Moh. Adjie pratignyo is a surgeon in Jakarta, Indonesia specializing in pediatric surgery. He has worked at several hospitals and currently works full-time at a private hospital in Tangerang, Banten. 2. Circumcision is the most common surgical procedure worldwide. It has a long history dating back thousands of years for religious, cultural and medical reasons. Modern medical circumcision aims to maximize benefits and minimize complications. 3. The benefits of circumcision include prevention of UTIs, reducing risk of HIV/AIDS, penile cancer and HPV. The risks include bleeding, infection and potential issues with healing. Timing, technique and devices all impact outcomes.

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Makbruri Abdul Aziz
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128 views43 pages

Overview of Circumcision

1. Moh. Adjie pratignyo is a surgeon in Jakarta, Indonesia specializing in pediatric surgery. He has worked at several hospitals and currently works full-time at a private hospital in Tangerang, Banten. 2. Circumcision is the most common surgical procedure worldwide. It has a long history dating back thousands of years for religious, cultural and medical reasons. Modern medical circumcision aims to maximize benefits and minimize complications. 3. The benefits of circumcision include prevention of UTIs, reducing risk of HIV/AIDS, penile cancer and HPV. The risks include bleeding, infection and potential issues with healing. Timing, technique and devices all impact outcomes.

Uploaded by

Makbruri Abdul Aziz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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sirkumsisi

Moh. Adjie pratignyo


Curiculum vitae
• Moh. Adjie pratignyo
• Jakarta 27 desember 1967
• FKUI 1992
• Bedah umum FKUI 2003
• Bedah anak FKUI 2011
• Fulltimer surgeon RS swasta ,tangerang Banten
• Specialist technical advisory group SUNATHRONE
KLAMP 2017- now
• Dewan Penasehat Asosiasi Dokter Khitan Seluruh
Indonesia ( Asdoki )
definition

• Circumferential + excision

• The # 1 list surgical procedure

• 1/6 human population


History of circumcision
• Started when and where ?
• Mummy in Egypt ( 2300 BC)

• “ heliolithic culture “ since 15000

• ( africa tribes/ harvest, american/ colombus,


aborigin, SEA , india moslem )
Slavery of warrior (insulted )

Cheap slave
biblical
• Covenant of Abraham’s descenden
Babylonian Talmud ( 500 CE )
Jew’s tool
• Biblical time : church “ social control “

Baby ( mark )and adolescence (produce)


Medical era
• Sir Frederick Treves :
• Scissor , a. Frenulum ligated, interrupted
suture, inner preputium optimally removed

• Grossman : cut without clamping (


problematic )
• Doyen : crusher
Moskovich 1920
• Moskovich (1920)
Harris clamp (1932)
Winkle mann
• First using glans shield Winkle mann and
Gomco (1939), Mogen (1955)

• Disposible device ERA


• 1950 Plastibell
Disposible device
• Accucirc (2004)
• Alis klamp (2003)
• Ismail klamp (2008)
• Mahdian Klamp
• Prepex ( 2009), shang Ring (2003)
• Smart klamp ( 2001 )
• Sunathrone ( 2006)
• Tara klamp ( 1992 )
circumcision
• Religion , culture, medicine
• Industry

• Medical’s view ; benefit and risk


• max goal, min complication
• COST effectiveness
Indication and contra
• Indication ; phimosis, paraphimosis, balanitis
Contra indication
• Anatomical anomaly
contraindication
Benefit and Risk of Circumcision
• Prevention of ;
• UTI, HIV aids , penile cancer and
• HPV, HSV
• Cervical cancer
• No sexual activity disturbance
• Women’s preferrence ( hygiene, sex act, STI,
enjoyable)
Risk/ Complication
• Acute : bleeding. Infection, glans trauma,
ischemia or necrosis

• Chronic : adhesion, skin loss, chordee, urethral


fistula, buried penis
Early complication
Late complication
Late complication
Subacute complication
Timing
• Infancy is the best
• No suture
• Fast healing
• Least bleeding and low adverse event
• More protecting
Free hands circumcision
• Dorsal slit

• Forcep guided

• Sleeve excision

• Window circumsion
Dorsal slit
Forcep guided
Sleeve excision
window
Type of devices

• 1. crush : mogen , gomco

• 2. clamping mk,ak, str

• 3. ligature p bell, shang ring, stapler

• HAEMOSTATIC AND APPROXIMATION


CRUSH
• Mechanism of action
• Crush for haemostatic and manual
approximation

• Sutureless, haemostatic less reliable


• For adult MC , no report, re use ( wear and
tear )
Crushing device
CLAMP
• Mechanism of action
• CLAMP ; ischemia and necrosis

• 2 purpose of clamp : haemostasis and


approximating
• Sutureless, reliable haemostatic, disposable
The clamp
devices
ligature
• Mechanism of action
• Ligation : haemostatic
stapler
• Mechanism of action
• Stapler for approximating
• Direct compression and gasket (?) for
haemostatic
Preputial thickness :
COSTLY
Small device
stapler
WHO preference ?
• 2011 formed Technical Advisory Group

• A shortlist for local consideration , no


favouring one device for globally
Best criteria of devices
• 1. protec the glans
• 2. postion for preputium
• 3. provide line for preputium excision
• 4. remove the preputium adequately
• 5. low adverse effect
• 6. Simple to apply and learn
• 7. good haemostatic
• 8. good result cosmetically
• 9. sterile
• 10. low cost

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