Comment & Debate
Philip G. Klotz. “In Defence of Circumcision”. Canadian Medical Association. 9 Oct. 1966 – I am convinced that most of the current difficulties that follow routine circumcision stem from the improper use of the Gomco clamp and the Plastibell technique.
These instruments are difficult to use properly, and engender a fear on the part of the operating physician that too much prepuce may be excised. As a consequence, too little is usually removed, resulting in partial circumcision, or the clamp is not left on long enough for adequate hemostasis to result, or preputial adhesions are inadequately freed. It has always been my practice not to use mechanical devices, either in adults or in the routine circumcision of infants. Circumcision is a delicate plastic surgical procedure. Both layers of tissue should be accurately incised and the underlying vessels should be clamped and ligated. Accurate suture apposition of skin edges is then possible, thereby eliminating the problem of excess removal of tissue, secondary hemorrhage and infection. Infection following circumcision is so unusual as to be a rarity in cases operated on in this way. The technique is applicable in newborns and in adults.
Circumcision should not be abandoned because it has been poorly performed in the past as a result of reliance on mechanical gadgets rather than sound surgical principles. It is my belief that adequate surgical circumcision of newborns should be a routine.