title: Pediatric sutureless circumcision: an effective and cost efficient alternative.
abstract: BACKGROUND
  Circumcision is the most commonly performed surgical procedures in male children. Maine is one of 18 states in the United States which does not pay for neonatal circumcisions. The aim of this study was to perform outcomes and cost analysis of a sutureless circumcision technique versus circumcision using sutures. Specifically, we evaluated Dermaflex (2-octyl cyanoacrylate, 2-OCA) surgical glue circumcision as a cost effective, faster, and safe alternative to traditional suture circumcision.
  
  
  METHODS
  Our study was a non-randomized series. We collected the operative details prospectively, abstracted clinical outcomes retrospectively, and performed data analysis retrospectively. One hundred and twenty-six circumcisions were performed by two pediatric urologists over a 1 year period. Suture circumcisions were performed exclusively during the first 6 months, and 2-OCA glue circumcisions were performed during the second 6 months. Billing charges were analyzed to extrapolate variable costs between the two surgical procedures. The technique used to perform the sutureless circumcision was a modification of the standard sleeve technique, with the use of monopolar diathermy instead of scalpel, and application of 2-OCA glue to approximate tissue edges.
  
  
  RESULTS
  From Jan 2013 to Jan 2014, 72 patients underwent circumcision with suture, and 54 patients underwent circumcision with 2-OCA glue. Mean age in the glue group was 61 months (range 8-202 months), and 50 months in the suture group (range 5-215 months), p = 0.19. All cases were performed under general anesthesia, as outpatient surgery. Mean operative cut time was 18.4 min for the glue group, and 28.6 min for the suture group (p < 0.01). The 10.2 min operative time difference translated to a $378 cost savings per glue circumcision case. Complication rates were not statistically significant between the two groups.
  
  
  CONCLUSIONS
  The use of 2-OCA tissue adhesive for sutureless circumcision is an alternative to the standard technique. It results in faster operative times, with a significant cost savings, while maintaining comparable complication rates to the standard suture technique. This is a viable, less expensive surgical option for patients whose circumcisions are not covered by Medicaid.
authors.affiliation: Maine Medical Center, Portland, Maine, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Voznesensky
authors.forename: Christopher
authors.initials: C
authors.lastname: Mutter
authors.forename: Matthew
authors.initials: M
authors.lastname: Hayn
authors.forename: Thomas
authors.initials: T
authors.lastname: Kinkead
authors.forename: Brian
authors.initials: B
authors.lastname: Jumper
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003487:Cyanoacrylates / Q000191:economics / Q000627:therapeutic use*; D004564:Electrocoagulation; D006801:Humans; D007223:Infant; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D013536:Suture Techniques / Q000191:economics; D014014:Tissue Adhesives / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome; D058106:Wound Closure Techniques
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate