Late complications following infant male circumcision using Plastibell technique: Experience from a single facility in Pakistan

• There are few reports on the late complications of circumcision with varying outcomes; these often lack group follow-up, and similarity of method of circumcision and type of provider. • Our group-based study utilized a standardized approach and demonstrated a minimal rate of late complications following circumcisions performed by trained health workers using the Plastibell technique. • Our findings emphasize the importance of training health workers in safe and standardized circumcision techniques to minimize procedural complications. Globally, millions of circumcisions are performed annually by both medical and non-medical providers, with minor and major adverse outcomes. Short-term outcomes are well documented but there are limited reports of long-term, group-based assessments after Plastibell circumcision of infants. Through this study, we aim to assess the rate and types of late complications in the group of boys circumcised as part of Safe Circumcision Program (SCP) in Karachi, Pakistan, to document the safety of our technique and approach in the long-term. This cross-sectional study was conducted on male infants circumcised via Plastibell technique as part of the SCP from June 2016 to May 2021. A sample size of 602 was calculated using OpenEpi. After obtaining consent, telephone interviews of parents/guardians were conducted by health workers using a structured questionnaire. All complications reported by parents and identified by health workers were documented, and the babies were then referred to a pediatric surgeon for review. Parents of 46 (7.5%) children reported a total of 81 concerns. After health worker assessment, 20 babies were referred to a specialist for in-person review and complications were documented in four (adhesion, inclusion cyst, skin bridge and meatal stenosis); thus, a late complication rate of 0.7% was recorded. The long-term complication rate for Plastibell circumcisions performed by trained providers is less than 1% with all reported complications minor and amenable to surgical correction.