Plastibell



The Plastibell Circumcision Device, invented by Hollister in 1950, is a clear plastic ring with handle designed for male neonatal circumcision. The ring has a deep groove running circumferentially.

The Plastibell was introduced in the 1950s.

The adhesions between glans and foreskin are divided with a probe. Then the foreskin is cut longitudinally to allow it to be retracted and the glans (the head of penis) to be exposed. The Plastibell comes in 6 sizes. The appropriate one is chosen and applied to the head (the circumcision pictured at right is in this stage). The ring is then covered over by the foreskin. A ligature is tied firmly around the foreskin, crushing the skin against the groove in the Plastibell. Then the excess skin protruding beyond the ring is trimmed off. Finally, the handle is broken off at the end of the procedure. The entire procedure takes five to ten minutes, depending on the experience and skill of the surgeon.

As with all circumcisions, the procedure should involve adequate anaesthesia, using either EMLA cream, dorsal penile nerve block, penile ring block, or a combination of these prior to operation.

The ring falls off in 3 to 7 days leaving a circumferential wound that will heal over the following week. Typically, the glans will appear red or yellow until it has acclimatized to its new surroundings.

Advantages
The glans is protected during the procedure by the ring. Haemostasis (control of bleeding) is effective due to the ligature tie. Cosmetically, a predictable result is obtained due to the straight line of the ligature that causes the wound. It is a quick procedure once mastered - taking a few minutes to perform, and hopefully causing minimal discomfort for the baby.

No bandage is required, allowing easy monitoring for infection.

Healing occurs while the edges of the prepuce are secured in the ring, making skin bridges (where the foreskin's end heals to the glans' corona) unlikely.

Cosmetically, there will be little to no circumcision scar, though as usual with any circumcision, there will be a color change where the (formerly) inner and outer layers of foreskin meet.

Disadvantages
The Plastibell was introduced before medical devices were regulated by the Food and Drug Administration. It has never been subjected to the rigorous tests for safety that are required of new devices.

The ring must fall off before final healing can occur. Rarely, the tip of the glans may protrude through the ring and become swollen, trapping the ring in place. Blood transfusion risk 1 in 30,000 procedures (Wiswell).

Furthermore, because convalescence depends on a (temporarily) affixed medical device, risks of infection or hemorrhage due to the bell slipping or otherwise failing are greater than a Gomco clamp or similar entirely-supervised circumcision.

There are several reports in the medical literature of urinary retention after circumcision with the Plastibell device. One case resulted in death.

There also is a report of impetigo caused by Staphylococcus aureus when using the Plastibell.

Prevalence
At least 50% of American non-therapeutic infant circumcisions since 1980 have been performed with a Plastibell.