Stapler Vs Sleeve Circumcision; A Prospective Comparative Study Of Safety, Efficacy And Patient Satisfaction.

Background Male circumcision is a widely performed procedure in India, driven by cultural, religious, and medical factors, including improved penile hygiene and reduced risk of sexually transmitted infections. Two modern techniques, sleeve circumcision and stapler circumcision, have gained prominence. Sleeve circumcision involves surgical resection of the foreskin with a scalpel followed by suturing, while stapler circumcision uses a disposable device to cut and staple the wound simultaneously. Despite their increasing use, there is limited comparative data on their efficacy, safety, and postoperative outcomes in the Indian population. This study aims to evaluate these techniques to guide clinical decision-making.   Methods A randomized controlled trial was conducted in India involving adult males undergoing circumcision. Participants were assigned to either sleeve circumcision (n=50) or stapler circumcision (n=50). Sleeve circumcision was performed using a scalpel with absorbable sutures, while stapler circumcision utilized a disposable anastomotic device. Key parameters assessed included operative time, intraoperative and postoperative pain (measured via Visual Analog Scale), blood loss, healing time, complication rates (e.g., infection, hematoma), and cosmetic outcomes (rated by patient satisfaction and clinician assessment). Data were analyzed using t-tests for continuous variables and chi-square tests for categorical variables, with a significance threshold of P<0.01.   Results Stapler circumcision significantly reduced operative time (6.8 ± 3.1 vs. 24.2 ± 3.2 minutes, P<0.01) and blood loss (1.8 ± 1.8 vs. 9.4 ± 1.5 mL, P<0.01) compared to sleeve circumcision. Intraoperative pain scores were lower with stapler circumcision (0.8 ± 0.5 vs. 2.4 ± 0.8, P<0.01), as were postoperative pain scores (4.0 ± 0.9 vs. 5.8 ± 1.0, P<0.01). Complication rates were lower in the stapler group (2.7% vs. 7.8%, P<0.01), with fewer instances of infection and hematoma. However, sleeve circumcision yielded superior cosmetic outcomes, with 92% of patients reporting high satisfaction due to smoother, natural-looking wounds compared to 78% in the stapler group (P<0.01). Stapler circumcision required staple removal in 85% of cases, while sleeve circumcision necessitated more intensive postoperative care.   Conclusion Both sleeve and stapler circumcision techniques are safe and effective in the Indian context, with distinct advantages. Stapler circumcision offers shorter operative times, reduced blood loss, lower pain, and fewer complications, making it suitable for patients prioritizing rapid recovery. Conversely, sleeve circumcision provides better cosmetic results, appealing to those valuing aesthetic outcomes. The choice of technique should be tailored to patient preferences, clinical settings, and resource availability. Further studies are needed to assess long-term outcomes and patient satisfaction in diverse Indian populations.