Sleeve resection is the most commonly used method for circumcisions in older children. Some form of anesthesia (a regional nerve block or general anesthesia) is given. Two cuts are made side by side in the shape of a ring on the shaft of the penis. The skin between the cuts are removed and the two edges are sewn together. The location of the healed scar will depend on where the cut closest to the glans is made. Stitches used will absorb into the skin, so removal is not necessary. The procedure takes approximately 30 minutes and healing time is 3 weeks. However, your child can return to school in 3-5 days.
A small child may occasionally be able to receive a circumcision using a plastibell device, a method usually reserved for infants. The Plastibell circumcision device is a clear lightweight plastic in the shape of a bell with an attached handle (see photograph). It comes in various sizes to fit newborns, infants and toddlers. The bell portion is designed to cover the glans while the foreskin is pulled over it and secured with a string (ligature). The ligature sits in a groove at the top of the bell so that when tied, the ligature will compress the excess foreskin, cutting off its circulation. The unwanted foreskin can now be removed by cutting around the bell while it protects the glans from injury.
The key is choosing the correct size device since too large a bell will cause excessive tension on the remaining foreskin and pull the bell over the glans onto the penile shaft. On the other hand, too small of a bell size could result in an inadequate amount of foreskin removed; also a small bell can put excessive pressure on the glans, causing a visible deformity. An experienced provider will choose the appropriate size device and perform the procedure in 5-10 minutes. Healing time is slightly longer in older children, lasting up to 3 weeks.
Performing a circumcision produces significant discomfort if done without the use of an anesthetic. Anesthetic medications taken by mouth, injected or inhaled will alleviate pain. Circumcisions for older children can be performed under local or general anesthesia.
Local Anesthesia ( Nerve Block)
Local anesthesia involves the injection of anesthetic medications on or around a nerve to control pain in a specific area of the body. They are sometimes used in combination with a sedative medication for pain management during circumcision. They work by temporarily blocking the pain pathways that connect the spinal cord to the brain. Consequently, pain sensation is not recognized. Nerve blocks are safe and effective options for those who do not desire general (sleep) anesthesia.
Kids (1yr -9yr) : $1250