The following is the summary of “Sutureless circumcision using monopolar diathermy and 2-octyl cyanoacrylate is safe and effective in a cohort of 634 post-neonatal prepubescent boys” published in the December 2022 issue of Pediatric urology by Lovin, et al.

One-third of all males are circumcised around the world, making circumcision the most prevalent surgical surgery. There is a wide range in the complication rates seen after suturing a circumcision performed on a child after birth but before puberty. Primary circumcision (2-octyl cyanoacrylate, Dermabond, Ethicon) and circumcision revision (CR) in prepubescent infants performed with 2-OCA showed greater cosmesis, quicker operating room (OR) times, and cost savings, according to their earlier findings. Their  research aims to determine whether or not 2-octylcyclohexanone (2-OCA) can be used to perform primary circumcision (PC) and circumcision revision (CR) without the need for sutures. After receiving approval from the Institutional Review Board, researchers looked back at all of the male patients who had PC or CR with 2-OCA and monopolar diathermy at their facility between January 2014 and January 2021. One surgeon handled all of the operations. This method is depicted in the image that follows. This procedure did not include the use of any devices or sutures to aid with alignment.

Patients who, due to their age or the presence of concomitant malformations, required sutures or compressive dressings, were not included in the study. Utilizing the REDCap database, researchers collected all returns to our system within 30 days of the procedure and all returns to the OR during the study period. During the study period, 1,107 procedures were carried out; 634 of these procedures (479 PC and 155 CR) were considered eligible for inclusion. At the 1-year mark, the median age was 12 months (range, 3 months-10.4 years). Within 30 days, 1% of patients required surgical intervention, and 4% of patients returned to the system due to surgery site hemorrhage. After 30 days, reoperation was necessary for 9 patients; 5 had iatrogenic phimosis, 3 had superfluous prepuce, and 1 had developed a keloid. Overall, researchers found a 1.3% complication rate (6/634), with a reoperation rate of 1.6% (10/634).

About 2-OCA has been widely used as an alternative to sutures for tension-free wounds since the FDA approved it in 1998. Concerns about wound dehiscence and surgical site hemorrhage have prevented its broad adoption for circumcision. This research shows that compared to reported circumcision with a knife and sutures, complication and reoperation rates are reduced when employing a scalpel-free and suture-less approach. Weaknesses include a lack of diversity in surgeon experience and the fact that the REDCAP database can only detect patients who experienced complications requiring a readmission. Compared to sutured circumcision (>1.7%) described in post-neonatal prepubescent boys, their technique for suture-less circumcision utilizing 2-OCA offers greater cosmesis, shorter OR waits, cost savings, and a reduced complication rate (1.3%).