Postoperative aesthetic and healing features of postectomy using three different surgical techniques: a randomized, prospective, and interdisciplinary analysis.

Bruno Pinheiro Falcão,Sérgio Bernardo Tenório,Marcelo Marcondes Stegani,Jorge Eduardo Fouto Matias

doi:10.1590/0100-6991e-20202626

Bruno Pinheiro Falcão, Sérgio Bernardo Tenório + Show 2 more

Open Access

https://doi.org/10.1590/0100-6991e-20202626

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Abstract

to compare the postoperative esthetic and healing aspects of postectomy performed by different surgical techniques, based on the evaluation of different specialty expert professionals. prospective and randomized clinical trial enrolling 149 preschool children with a medical indication for circumcision, divided into three groups: postectomy with the hemostatic device Plastibell® (PB group), conventional technique (CV group) and conventional with subcuticular stitches (SC group). Pictures were taken from patients at pre-defined angles on the 30th and 60th postoperative days. Photos were evaluated by three specialists (dermatologist, pediatrician and plastic surgeon), who assigned scores from 1 to 5 regarding the esthetic and healing features at each moment. Grades 4 or 5 from all specialists characterized "best result". Data were analysed to compare the used surgical techniques, the judgments from specialties and postoperative complications. most of the patients obtained the "best result" regarding healing (70%) and esthetics (56%). The final overall result showed the PB group as the best for healing (p=0.028) and the SC group as the best for esthetics (p=0.002). For the dermatologist, on the 60th postoperative day, the CV group presented the worst aesthetic result, whereas for the pediatrician and the plastic surgeon, the PB group presented the best healing result and the SC group had the best esthetic result. There was no difference between the groups regarding the presence of complications. the most common surgical techniques used to perform postectomy in children were differently assessed regarding healing and esthetic features by distinct medical professionals. The analysis of these two parameters among experts from related areas diverged among them and over time.

Highlights

Phimosis is defined as the inability to completely retract the foreskin and expose the glans, due to congenital or acquired constriction of the foreskin[1,2,3,4]
Postectomy or circumcision, the treatment recommended for phimosis, is one of the oldest and most common surgical procedures worldwide[6,7] and consists of the removal of part or all of the penis foreskin[8], aiming at sufficient exposure of the glans in order to solve the problem, whether phimosis or paraphimosis
In the PB group, patients underwent postectomy with a hemostatic device called Plastibell®; in the CV group, children were operated on using the conventional technique; and in the SC group, 50 children underwent conventional postectomy with separate subcuticular stitches

Summary

Introduction

Phimosis is defined as the inability to completely retract the foreskin and expose the glans, due to congenital or acquired constriction of the foreskin[1,2,3,4]. Postectomy or circumcision, the treatment recommended for phimosis, is one of the oldest and most common surgical procedures worldwide[6,7] and consists of the removal of part or all of the penis foreskin[8], aiming at sufficient exposure of the glans in order to solve the problem, whether phimosis or paraphimosis. Postectomy methods can be classified into three types or combinations of these: postoplasty, hemostatic devices, and conventional prepuce resection[9,10]. Conventional surgery and the use of Plastibell® are the procedures of choice. Plastibell® was originally developed for neonatal circumcision, but has been later adapted for circumcision in childhood[11,12]

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