title: Comparison of a CO2 (Carbon Dioxide) Laser and Tissue Glue with Conventional Surgical Techniques in Circumcision.
abstract: BACKGROUND
  CO2 (Carbon Dioxide) laser application in circumcision, for cutting and coagulation, has been reported to have excellent results. Also, tissue glue has been reported to have advantages over sutures for approximation of wound edges. Most previous studies focused on comparisons between CO2 laser and scalpel, or between tissue glue and sutures. This study prospectively compared the results and complications CO2 laser and tissue glue, with standard surgical techniques in circumcision.
  
  
  METHODS
  Thirty boys were prospectively divided into two groups. Group 1 (n = 17) underwent circumcision by scalpel with approximation of the wound edges using chromic catgut sutures. Group 2 (n = 13) underwent circumcision with CO2 laser and approximation of the wound edges using tissue glue. Patient age, indications for surgery, operative time, wound swelling, bleeding, wound infection, local irritation, pain score, and cosmetic appearance were recorded.
  
  
  RESULTS
  Group 1 had a significantly longer operative time (P= 0.011), higher rate of local irritation (P= 0.016), and poorer cosmetic appearance (P< 0.001) than group 2. Bleeding only occurred in one patient in group 1. There were no significant differences in pain score, wound infection rate, or cost of surgery between the two groups.
  
  
  CONCLUSIONS
  CO2 laser and tissue glue have advantages over standard surgical techniques in circumcision, with a significantly shorter operative time, lower rate of local irritation, and better cosmetic appearance. The cost of surgery is similar between the two groups.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Akkrapol
authors.initials: A
authors.lastname: Mungnirandr
authors.affiliation: Perioperative Nursing Division, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Suwanna
authors.initials: S
authors.lastname: Wiriyakamolphan
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Ravit
authors.initials: R
authors.lastname: Ruangtrakool
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Monawat
authors.initials: M
authors.lastname: Ngerncham
authors.affiliation: Utilization Management Unit, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Sureerat
authors.initials: S
authors.lastname: Tumrongsombutsakul
authors.affiliation: Utilization Management Unit, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Bungorn
authors.initials: B
authors.lastname: Leumcharoen
keywords: CO2 laser; children; circumcision; tissue glue