Retrospective analysis of clinical outcomes and early complications of conventional circumcision techniques and thermocautery-assisted circumcision

This study compared various circumcision techniques, specifically the dorsal slit (DS), sleeve resection (SR), and forceps-guided (FG) techniques, which fall under the category of conventional circumcision techniques, with the thermocautery-assisted circumcision (TAC) technique. The aim was to investigate the safety and efficacy of these circumcision methods by focusing on clinical outcomes and early complications, categorizing the associated complications using the Clavien-Dindo classification system (CDCS). A total of 7041 circumcised patients were retrospectively analyzed and grouped according to the applied techniques: DS, SR, FG, and TAC. Factors such as age, duration of the procedure, bleeding, edema, infection, recovery time, and local anesthetic technique parameters were compared. Complications were classified according to the modified CDCS. The duration of the procedure was 4.7 min (range 4.5-5.2), and bleeding (hematoma) was significantly lower in the TAC group with seven cases (0.3%) (p < 0.001). The recovery time of 5 days (range 5-7 days) and the incidence of edema were longer in TAC compared to other techniques (p < 0.001). Additionally, the recovery time in the SR group was shorter than that of the FG and DS groups (p < 0.001). After adjusting for confounding factors such as age, duration of the procedure, and local anesthetic techniques, the likelihood of perioperative bleeding was observed to statistically significantly increase in the FG (odds ratio [OR] = 61.663, 95% confidence interval [CI] 42.764-88.913, p < 0.001), DS (OR = 59.249, 95% CI 39.382-89.141, p < 0.001), and SR (OR = 161.952, 95% CI 96.100-272.930, p < 0.001), in that order, compared to the TAC group. Furthermore, compared to the TAC group, the likelihood of severe edema statistically significantly decreased in the FG (OR = 0.010, 95% CI 0.004-0.027, p < 0.001), DS (OR = 0.040, 95% CI 0.017-0.092, p < 0.001), and SR (OR = 0.043, 95% CI 0.015-0.124, p < 0.001) groups, in that order. There was no significant difference between the surgical techniques according to the CDCS evaluation. TAC demonstrated advantages over the remaining techniques in terms of less bleeding and shorter duration of the procedure. However, it also presented with disadvantages such as postoperative edema and longer recovery time.