Ritual circumcision: no longer a problem for health services in the British Isles.
BACKGROUND
Primary care trust (PCT) funding of a ritual circumcision service has recently been withdrawn from our unit, raising concerns that this may result in greater morbidity from community circumcision. The aims of this study were to document our circumcision practice before and after the withdrawal of PCT funding and to determine its effect on the morbidity from circumcision. In addition, we wanted to survey all paediatric surgical centres in the British Isles to ascertain how many still offer a ritual circumcision service.


METHODS
We retrospectively reviewed our circumcision practice for 1 year prior to the removal of UK Government funding, and then performed a prospective audit of our practice for the 12 months following funding withdrawal. An e-mail survey was also performed of all paediatric surgical units to determine the ritual circumcision service provision throughout the British Isles.


RESULTS
A total of 213 boys underwent circumcision during the 12 months prior to the withdrawal of funding, of which 106 cases (50%) were ritual circumcisions. After funding withdrawal, 99 boys underwent circumcision, of which 98 cases (99%) were for medical reasons. A similar number of boys were re-admitted after a hospital circumcision during the two review periods (5 versus 4 patients), whereas the number admitted following a community circumcision rose after funding withdrawal (6 versus 11 patients). Only a third of British paediatric surgical centres offer a ritual circumcision service, and a significant pro- portion of these were either providing the service without PCT funding, or were reconsidering their decision to continue.


CONCLUSIONS
PCT funding withdrawal for ritual circumcision had an impact on our unit's procedural case volume. This represented a cost saving to the trust, despite a higher rate of admissions for postoperative complications. There is an inequality in healthcare provision throughout the British Isles for ritual circumcision, and we feel it is vital to offer support and training to medical and non-medical practitioners who are being asked to perform a greater number of circumcisions in the community.
Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Trust, London, UK.
G K
GK
Atkin
C
C
Butler
J
J
Broadhurst
A
A
Khan
R
R
Nataraj
N
N
Madden
M
M
Haddad
S A
SA
Clarke
D000293:Adolescent; D002562:Ceremonial Behavior; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000009:adverse effects / Q000191:economics* / Q000592:standards; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom