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[[Image:Plastibell.jpg|right|thumb|A circumcision device that uses string to cut off blood flow to the foreskin, amputating it ]]
[[Image:Plastibell.jpg|right|thumb|A circumcision device that uses string to cut off blood flow to the foreskin, amputating it ]]
The '''Plastibell''' circumcision device is a clear plastic ring with a deep groove running circumferentially designed for circumcising infant males. It was invented by Hollister Inc in 1950, and first reported on in 1953.<ref name=Miller1953>{{MillerSnyder1953}}</ref><ref name=Kariher1956>{{REFjournal
The Plastibell Circumcision Device is a clear plastic ring with a deep groove running circumferentially designed for circumcising infant males. It was invented by Hollister Inc in 1950, and first reported on in 1953.<ref name=Miller1953>{{REFjournal
  |last=Kariher
| last=Miller
  |init=DH
| first=RL
  |last2=Smith
| coauthors=Snyder DC
|init2=TW
| pubyear=1953, January
  |date=1956-01
| title=Immediate circumcision of the newborn male
  |title=Immediate circumcision of the newborn
| journal=Am. J. Obstet. Gynecol.
  |journal=Obstet Gynecol
| volume=65
  |volume=7
| issue=1
  |issue=1
| pages=1-11
  |pages=50-3
| url=
  |url=
| quote=
  |quote=
| pubmedID=13016660
  |pubmedID=13280246
| accessdate=
  |accessdate=
}}</ref><ref name=Kariher1956>{{REFjournal
}}</ref> The device works by providing a circumferencial surface upon which to tie off the [[foreskin]].
  | last=Kariher
  | first=DH
  | coauthors=Smith TW
  | pubyear=1956, January
  | title=Immediate circumcision of the newborn
  | journal=Obstet Gynecol
  | volume=7
  | issue=1
  | pages=50-3
  | url=
  | quote=
  | pubmedID=13280246
  | accessdate=
}}</ref> The device works bo providing a circumferencial surface upon which to tie off the foreskin.


==Advantages==
==Advantages==


The [[glans]] is protected during the procedure by the ring. Hemostasis (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 for the physician to perform — once mastered.
The [[glans]] is protected during the procedure by the ring. Hemostasis (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 for the physician to perform—once mastered.


No bandage is required, allowing easy monitoring for [[infection]].  
No bandage is required, allowing easy monitoring for [[infection]].  


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


==Disadvantages==
==Disadvantages==


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 is 1 in 30,000 procedures (Wiswell).
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).


One study of 2000 Plastibell circumcisions found a complication rate of 1.8%.<ref>{{REFjournal
One study of 2000 Plastibell circumcisions found a complication rate of 1.8%.<ref>Izzidien Al-Samarrai A.Y., Mofti A. Crankson S. J The Use of Plastibell in Neonatal Circumcision. Review of 2000 cases. Surg. Gyne & Obst.167: 341-343, 1988<!--{{vs|couldn't find|date=November 2012}}--></ref>
|last=Izzidien Al-Samarrai
|init=AY
|last2=Mofti
|init2=A
|last3=Crankson
|init3=SJ
|title=The Use of Plastibell in Neonatal Circumcision. Review of 2000 cases
|journal=Surg. Gyne & Obst.
|volume=167
|pages=341-343
|date=1988
}}</ref>


The [[foreskin]] must be slit and forced from the glans to allow entry for the plastic dome.
The [[foreskin]] must first be slit and forced from the [[glans]] to allow entry for the plastic dome.


Furthermore, because convalescence depends on a (temporarily) affixed medical device, risks of [[infection]] or [[bleeding| hemorrhage]] due to the bell slipping or otherwise failing are greater<ref>{{REFnews
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| Gomco clamp]] or similar entirely-supervised circumcision.
|last=Brennae
|first=Mark
|url=http://www.canada.com/vancouversun/story.html?id=cb3b8281-4134-46ba-85d3-b076072bda75&k=25810
|title=Ontario boy dies after complications from circumcision
|date=2007-06-13
|publisher=The Vancouver Sun: CanWest News Service
|quote=
|accessdate=2008-07-16
}}</ref> than a [[Gomco|Gomco clamp]] or similar entirely-supervised circumcision.


There are several reports in the literature of urinary retention after [[circumcision]] with the Plastibell device.<ref>{{REFjournal
There are several reports in the literature of urinary retention after circumcision with the Plastibell device.<ref>{{REFjournal
  |last=Ly
  | last=Ly
  |init=L
  | first=L
  |last2=Sankaran
  | coauthors=Sankaran K
|init2=K
  | pubyear=2003
  |date=2003
  | title=Acute venous stasis and swelling of the lower abdomen and extremities in an infant after circumcision
  |title=Acute venous stasis and swelling of the lower abdomen and extremities in an infant after circumcision
  | journal=CMAJ
  |journal=CMAJ
  | volume=169
  |volume=169
  | issue=3
  |issue=3
  | pages=216-7
  |pages=216-7
  | url=https://www.cmaj.ca/content/169/3/216.long
  |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC167126/
  | quote=
  |quote=
  | pubmedID=12900483
  |pubmedID=12900483
  | accessdate=2025-04-23
  |accessdate=2020-04-22
}}</ref> [[Death]] has been reported.<ref>[http://www.pulsus.com/Paeds/12_04/Pdf/zwol_ed.pdf Paediatrics & Child Health, Home<!-- Bot generated title -->]</ref><ref>http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/vic/VCAT/2010/1772.html?stem=0&synonyms=0&query=anaesthetic</ref><ref>{{REFjournal
}}</ref> [[Death]] has been reported.<ref>[http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/vic/VCAT/2010/1772.html?stem=0&synonyms=0&query=anaesthetic Medical Board of Australia v Jabbar] (Occupational and Business Regulation) [2010] VCAT 1772 (5 November 2010)</ref><ref>{{REFjournal
  | last=Paediatric Death Review Committee: Office of the Chief Coroner of Ontario
  |last=Paediatric Death Review Committee: Office of the Chief Coroner of Ontario
  | first=
  |first=
  | coauthors=
  |date=2007  
| pubyear=2007  
  |title=Circumcision: A minor procedure?  
  | title=Circumcision: A minor procedure?  
  |journal=Paediatrics & child health
  | journal=Paediatrics & child health
  |volume=12
  | volume=12
  |issue=4
  | issue=4
  |pages=311-2
  | pages=311-2
  |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528673/
  | url=https://pmc.ncbi.nlm.nih.gov/articles/PMC2528673/
  |quote=
  | quote=
  |pubmedID=19030377
  | pubmedID=19030377
  |pubmedCID=2528673
  | pubmedCID=2528673
  |accessdate=2019-11-13
  | accessdate=2025-04-25
}}</ref>
}}</ref>


There also is a report of impetigo caused by ''Staphylococcus aureus'' when using the Plastibell.<ref>{{REFjournal
There also is a report of impetigo caused by Staphylococcus aureus when using the Plastibell.<ref>{{REFjournal
  |last=Stranko
  | last=Stranko
  |init=J
  | first=j
  |last2=Ryan
  | coauthors=ME Ryan, AM Bowman
|init2=ME
  | pubyear=1986
|last3=Bowman
  | title=Impetigo in newborn infants associated with a plastic bell clamp circumcision
  |init3=AM
  | journal=Pediatric infectious disease
|date=1986-09
  | volume=5
  |title=Impetigo in newborn infants associated with a plastic bell clamp circumcision
  | issue=5
  |journal=Pediatric infectious disease
  | pages=597-9
  |volume=5
  | url=
  |issue=5
  | quote=
  |pages=597-9
  | pubmedID=3763425
  |url=http://www.cirp.org/library/complications/stranko1/
  | accessdate=
  |quote=
  |pubmedID=3763425
  |accessdate=2019-11-13
}}</ref>
}}</ref>


There have been multiple cases of children developing necrotizing fasciitis in their [[penis]] after being [[circumcised]] using the Plastibell device.<ref name=pubmed9329429>{{REFjournal
There have been multiple cases of children developing necrotizing fasciitis in their [[penis]] after being [[circumcised]] using the Plastibell device.<ref name=pubmed9329429>{{REFjournal
  |last=Bliss  
  | last=Bliss  
  |first=David P.
  | first=David P.
  |init=DP
  | coauthors=Patrick J. Healey, John H.T. Waldhausen
|last2=Healey
  | pubyear=1997  
|first2=Patrick J.
  | title=Necrotizing fasciitis after Plastibell circumcision
|init2=PJ
  | journal=The Journal of Pediatrics
|last3=Waldhausen
  | volume=131
|first3=John H.T.
  | issue=3
  |init3=JHT
  | pages=459-62
|date=1997  
  | url=
  |title=Necrotizing fasciitis after Plastibell circumcision
  | quote=
  |journal=The Journal of Pediatrics
  | accessdate=
  |volume=131
  | DOI=10.1016/S0022-3476(97)80078-9
  |issue=3
  | pubmedID=9329429
  |pages=459-62
  |url=http://www.cirp.org/library/complications/bliss/
  |quote=
  |accessdate=2019-11-13
  |DOI=10.1016/S0022-3476(97)80078-9
  |pubmedID=9329429
}}</ref><ref>{{REFjournal
}}</ref><ref>{{REFjournal
  |last=Woodside  
  | last=Woodside  
  |init=JR
  | first=JR  
  |date=1980-03
  | coauthors=
  |title=Necrotizing fasciitis after neonatal circumcision
| pubyear=1980  
  |journal=American journal of diseases of children
  | title=Necrotizing fasciitis after neonatal circumcision
  |volume=134
  | journal=American journal of diseases of children
  |issue=3
  | volume=134
  |pages=301-2
  | issue=3
  |url=http://www.cirp.org/library/complications/woodside2/
  | pages=301-2
  |quote=
  | url=
  |pubmedID=6444778
  | quote=
  |accessdate=2019-11-13
  | pubmedID=6444778
  | accessdate=
}}</ref>
}}</ref>


There have been cases of [[necrosis]] of the glans penis following [[circumcision]] with the Plastibell device.<ref>{{REFjournal
There have been cases of necrosis of the [[glans penis]] following circumcision with the Plastibell device.<ref>{{REFjournal
  |last=Bode
  | last=Bode
  |init=CO
  | first=C.O.
  |last2=Ikhisemojie
  | coauthors=S. Ikhisemojie, A.O. Ademuyiwa
|init2=S
  | pubyear=2010
|last3=Ademuyiwa
  | title=Penile injuries from proximal migration of the Plastibell circumcision ring
  |init3=AO
  | journal=Journal of Pediatric Urology
|date=2010
  | volume=6
  |title=Penile injuries from proximal migration of the Plastibell circumcision ring
  | issue=1
  |journal=Journal of Pediatric Urology
  | pages=23-7
  |volume=6
  | url=
  |issue=1
  | quote=
  |pages=23-7
  | pubmedID=19570722
  |url=https://www.researchgate.net/publication/256010137_Management_of_Plastibell_circumcision_ring_migration_and_glans_penis_incarceration
  | DOI=10.1016/j.jpurol.2009.05.011
  |quote=
  | accessdate=
  |pubmedID=19570722
  |DOI=10.1016/j.jpurol.2009.05.011
  |accessdate=2019-11-13
}}</ref>
}}</ref>


== "Non cutting"? ==
== "Non cutting"? ==


Plastibell is often described to parents as a non-cutting method. However, a [[dorsal slit]] (cut) is often performed at the beginning of the installation to make it easier to install the device. Once installed, the Plastibell cuts circulation to the [[foreskin]], necrotizing the tissue, which will fall off in a few days (or it might be 'trimmed' after installing the Plastibell). The result is the same: the [[amputation]] of a healthy [[foreskin]].
PlastiBell is often described to parents as a non-cutting method. However, a dorsal slit (cut) must often performed at the beginning of the installation to make it easier to install. Once installed, the PlastiBell cuts circulation to the [[foreskin]], necrotizing the tissue, which will fall off in a few days (or it might be 'trimmed' after installing the PlastiBell). The result is the same: the amputation of a healthy, functional foreskin.


[[Image:Plastibelldrwg.jpg]]
[[Image:Plastibelldrwg.jpg]]


== Video ==
<br>
* [https://med.stanford.edu/newborns/professional-education/circumcision/plastibell-technique.html Plastibell Technique]
{{SEEALSO}}
* [[Device displacement]]
* [[Dorsal penile nerve block]]
* [[Intraperitoneal bladder perforation]]
* [[Pain]]
* [[Trauma]]
{{LINKS}}
{{LINKS}}
* {{REFweb
 
|url=http://www.drmomma.org/2010/05/the-perils-of-plastibell-circumcision.html
|title=The Perils of Plastibell Circumcision: A Mythical "No Cutting, No Risk" Method
|last=Day
|first=Danelle
|website=[[Dr. Momma - peaceful parenting]]
|date=2010
|accessdate=2021-09-24
}}


{{REF}}
{{REF}}


[[Category:Circumcision product]]
[[Category:Circumcision]]
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