Sünnet Komplikasyonları: Sekiz yıllık deneyimimiz

Yıl 2020, Cilt: 17 Sayı: 2, 256 - 260, 20.08.2020

Mustafa Erman Dörterler

https://doi.org/10.35440/hutfd.762906

Cited By: 1

Öz

Amaç: Sünnet, dünyada en sık yapılan cerrahi işlemdir. Ülkemizde halen sünnetlerin büyük bir kısmı sağlık memurları veya sünnetçiler tarafından yapılmaktadır. Amacımız sünnete bağlı komplikasyon türlerini, sıklığını ve olası nedenlerini belirlemek.
Materyal ve metod: Çalışmaya Ocak 2012 ile Aralık 2019 tarihleri arasında sünnete bağlı şikayetler nedeni ile hastanemiz Çocuk Cerrahisi Kliniği’ne başvuran ve sünnet komplikasyonu saptanan 0-18 yaş arasında toplam 103 hasta alındı. Hastaların demografik verileri, uygulanan tedaviler ve klinik izlemleri retrospektif olarak dosya kayıtlarından elde edildi.
Bulgular: Hastalarının yaş ortalaması 3,9±3,8 yıl saptandı. Sünnetlerin 58’i (%56,3) ev veya sağlık kabininde, 45’i (%43,7) hastane koşullarında yapıldı. Bunların 68’i (%66) sünnetçi veya sağlık memuru tarafından, 35’i (%34) doktor tarafından yapıldı. En sık erken dönem sünnet komplikasyonu penil kanama veya hematom (%25,2), en sık geç dönem sünnet komplikasyonu yetersiz sünnet ve glansa yapışık cilt köprüleri (%17,5) olduğu saptandı. Hastaların 7’sinde (%6,7) majör komplikasyon (glans amputasyonu, penis cildinde nekroz ve sünnet derisinin fazla kesilmesi) saptandı. Bu hastaların 6’sı (%85,7) sağlık memuru veya sünnetçi tarafından sünnet edildi.
Sonuç: Sünnet, cerrahi işlem için gerekli şartların sağlandığı koşullarda uzman doktorlar tarafından yapılması gereken cerrahi bir işlemdir. Bu konuda toplumun bilinçlenmesi ile sünnete bağlı hem komplikasyonların sıklığı hem de ağır komplikasyon riski azalacaktır.

Anahtar Kelimeler

Cerrahi, Çocuk, Komplikasyon, Sünnet

Circumcision Complications: Our Eight-Year Experience

Öz

Background: Most circumcision practices in our country are still carried out by medical officers or circumcisers. The present study aims to determine the types of circumcision complications, their frequencies and possible causes.
Methods: A total of 103 patients between 0-18 years of age, who were admitted to the Pediatric Surgery Clinic of our hospital due to circumcision complaints between January 2012 and December 2019, were included in the study. The demographic data, treatments, and clinical follow-up of the patients were obtained from file records retrospectively.
Results: The mean age of the patients was 3.9 ± 3.8 years. Of the circumcisions, 58 (56.3%) were performed at home or in a health cabin, while 45 (43.7%) were conducted in a hospital setting. Of these, 68 (66%) were performed by a circumciser or health officer, and 35 (34%) by a physician. The most common early circumcision complication was penile hemorrhage or hematoma (25.2%) and the most common late circumcision complication was inadequate circumcision and glans adherent skin bridges (17.5%). The major complications were glans penile amputation, necrosis, and excessive incision of the penis skin in 7 (6.7%) patients. Of these patients, 6 (85.7%) were circumcised by a health officer or circumciser.
Conclusions: Circumcision is a surgical procedure that should be performed by specialist physicians where the necessary conditions for the surgical procedure are met. As society becomes more aware of this issue, the frequency of circumcision complications and the risk of severe complications will decrease.

Anahtar Kelimeler

child, Complication, Circumcision

Kaynakça

• 1. Prabhakaran S. Ljuhar D, Coleman R, Nataraja RM: Circumcision in the paediatric patient: a review of indications, technique and complications. J Paediatr Child Health. 2018;54:1299-1307.
• 2. Krill AJ, Palmer LS, Palmer JS. Complications of circumcision. ScientificWorldJournal. 2011;11:2458-68.
• 3. Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: A systematic review. BMC Urol. 2010;10:2.
• 4. Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J, et al. Estimation of countryspecific and global prevalence of male circumcision. Popul Health Metr. 2016;14:4.
• 5. Thorup J, Thorup SC, Ifaoui IB. Complication rate after circumcision in a paediatric surgical setting should not be neglected. Dan Med J. 2013;60(8):A4681.
• 6. American Academy of Pediatrics. Circumcision policy statement. Pediatrics. 2012;130:585-86.
• 7. Harrison N, Eshleman J, Ngugi P. Ethical issues in the developing world. Br J Urol. 1995;76:93-96. 8. Thorup J, Thorup SC, Ifaoui IB. Complication rate after circumcision in a paediatric surgical setting should not be neglected. Dan Med J. 2013;60(8):A4681.
• 9. Arlen AM, Merriman LS, Heiss KF, Cerwinka WH, Elmore JM, Massad CA, et al. Emergency room visits and readmissions after pediatric urology surgery. J Pediatr Urol. 2014;10(4):712-16.
• 10. Tuncer AA , Ayar Erten AA. Examination of Short and Long Term Complications of Thermocautery, Plastic Clamping, and Surgical Circumcision Techniques. Pak J Med Sci. 2017;33(6):1418-23.
• 11. Bhat NA, Raashid H, Rashid KA. Complications of Circumcision. Saudi J Med Med Sci. 2014:2;86-89.
• 12. Ceylan K, Burhan K, Yilmaz Y, Can S, Kuş A, Mustafa G. Severe Complications of Circumcision: An Analysis of 48 Cases. J Pediatr Urol. 2007;3(1):32-35.
• 13. Ozdemir E. Significantly Increased Complication Risks With Mass Circumcisions. Br J Urol. 1998;81(4):652.
• 14. Mustafa Erman Dörterler1, Osman Hakan Kocaman1, et al Harran Üniversitesi Tıp Fakültesi Dergisi (Journal of Harran University Medical Faculty) Cilt 13. Sayı 3, 2016 257-260
• 15. İnce B, Dadacı M, Altuntaş Z, Bilgen F. Rarely Seen Complications of Circumcision, and Their Management. Turk J Urol. 2016;42(1):12-15
• 16. Naji H, Mustafa R. Circumcision of preschool boys in Baghdad, Iraq: prevalence, current practice and complications. Front. Med. 2013;7:122-25.
• 17. Benli E, Koca O. Circumcision research in Bingol province. The New J Urol. 2011;6:22-25.
• 18. Gold G, Young S, O'Brien M, Babl FE. Complications following circumcision: Presentations to the emergency department. J Paediatr Child Health. 2015;51(12):1158-63.
• 19. Çeçen K, Kocaaslan R, Karadağ MA, Demir A, Cebeci OÖ, Uslu M. Evaluation about complications of specialists in 2220 circumcision cases. Medical Journal of Kocaeli 2014;1:11-14.
• 20. Kim JK, Koyle MA, Chua ME, Ming JM, Lee MJ, Kesavan A, et al. Assessment of risk factors for surgical complications in neonatal circumcision clinic. Can Urol Assoc J. 2019;13(4):E108-E112.
• 21. Talini C, Antunes LA, Carvalho BCN, Schultz KL, Del Valle MHCP, Aranha Junior AA, et al. Circumcision: Postoperative Complications That Required Reoperation. Einstein (Sao Paulo). 2018;16(3):eAO4241
• 22. Bode CO, Ikhisemojie S, Ademuyiwa AO. Penile injuries from proximal migration of the Plastibell circumcision ring. J. Pediatr Urol. 2010;6:23-27.
• 23. Nagdeve N, Naik H, Bhingare P, Morey S. Parental evaluation of postoperative outcome of circumcision with Plastibell or conventional dissection by dorsal slit technique: a randomized controlled trial. J. Pediatr Urol. 2013;9:675-82.
• 24. Bastos Netto JM, Gonçalves de Araújo JJr, Noronha MF, Passos BR, Lopes HE, Bessa Jd Jr, et al. A prospective evaluation of Plastibell® circumcision in older children. Int Braz J Urol. 2013;39(4):558-64.
• 25. Brisson PA, Patel HI, Feins NR. Revision of circumcision in children: Report of 56 cases. J Pediatr Surg. 2002;37(9):1343-4