Name of the Procedure:

Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age

Summary

Circumcision is a surgical procedure where the foreskin covering the tip of the penis is removed. This version of the procedure is done using surgical excision methods, rather than clamps, devices, or the dorsal slit technique and is performed on individuals older than 28 days of age.

Purpose

The procedure addresses various medical issues such as phimosis (where the foreskin cannot be retracted), recurrent infections, and balanitis (inflammation of the foreskin and head of the penis). The goals are to alleviate symptoms, prevent further infections, and improve overall penile hygiene.

Indications

• Phimosis
• Recurrent infections or inflammation (balanitis)
• Hygiene-related issues
• Paraphimosis (foreskin stuck in retracted position)
• Certain cases of penile cancer prevention

Preparation

• Patients may be required to fast for a certain period before the procedure.
• Pre-operative laboratory tests such as blood work may be necessary.
• Review and adjustment of current medications, particularly blood thinners.

Procedure Description

1. The patient is positioned comfortably and given anesthesia (local, regional, or general).
2. The surgical site is cleaned and sterilized.
3. The surgeon makes an incision at the foreskin and carefully removes it using a scalpel or scissors.
4. Bleeding is controlled, typically with electrocautery.
5. The remaining edges of the skin are sutured (stitched) together.
6. The surgical site is dressed with a sterile bandage.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

The procedure is usually performed in an outpatient clinic, surgical center, or hospital.

Personnel

• Surgeon
• Operating room nurse
• Anesthesiologist (if general or regional anesthesia is used)
• Surgical technician

Risks and Complications

• Infection
• Bleeding
• Pain
• Swelling
• Unsatisfactory cosmetic outcome
• Scarring
• Reduced sensitivity or sensation

Benefits

• Relief from phimosis and related symptoms
• Reduced risk of infections
• Improved penile hygiene
• Potential reduced risk of certain sexually transmitted infections (STIs)

Recovery

• Pain management with prescribed medications.
• Keeping the surgical site clean and dry.
• Avoiding strenuous activities for a few weeks.
• Wearing loose-fitting underwear.
• Follow-up appointments for wound assessment and suture removal (if non-absorbable stitches are used).

Alternatives

• Conservative treatments (topical steroids for phimosis)
• Use of foreskin stretching techniques
• Use of preputioplasty (a less extensive surgical procedure to loosen the foreskin)
• Each alternative may vary in effectiveness and risk.

Patient Experience

• Patients may feel discomfort or mild pain during the recovery period, which is managed with pain relief medications.
• Swelling and tenderness in the surgical area are common but should resolve within a few days to weeks.
• Overall discomfort generally diminishes significantly within a week.
• Detailed post-care instructions are provided to ensure a smooth recovery and minimize complications.