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Circumcision

248 bytes added, 21:51, 8 October 2019
Possible operative and postoperative complications: Add introductory language.
=== Possible operative and postoperative complications ===
 
Circumcision is surgery. Surgical complications of circumcision generally may be classified as hemorrhage, infection, or surgical misadventure up to and including loss of the penis and death.
* Intolerance or allergic reactions to the narcotics used.
* Especially in newborns, where the bodily pain reduction mechanisms are not yet fully developed, local anaesthesia is often insufficient for the operation. Even in conjunction with regional anaesthesia of the dorsal nerve of the [[penis]], the rate of failure to provide sufficient anaesthetic even for experienced anaesthetists is still 5-10%. The general anaesthesia that would be needed for newborns, however, poses significant risks for the child, and, therefore, is only likely to be used in emergencies. A surgical operation without proper pain control can lead to the development of a specific pain memory<ref>Prof. Dr. med. Boris Zernikow http://www.spiegel.de/spiegel/vorab/experte-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-849534.html</ref>. In unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation. Overall, their pain threshold was lower and the risk of chronic pain increased. Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice<ref>Garry T. Circumcision: a survey of fees and practices. ''OBG Management '' 1994. (October): 34-6.</ref><ref>Howard CR, Howard FM, Garfunkel LC, de Blieck EA, Weitzman M. Neonatal circumcision and pain relief: current training practices. ''Pediatrics '' 1998; 101:423-428.</ref><ref>Stang HJ, Snellman LW. Circumcision practice patterns in the United States. ''Pediatrics '' 1998; 101: e5. Link to [[AAP]] website</ref>. During procedures which take several minutes, babies tend to fall into a state of stupor, which in the past was falsely interpreted as peaceful sleep, nurturing the belief that babies felt no pain. Measurements taken in those cases revealed a typically 3- to 4-fold increase in cortisol levels, which equals a state of severe shock.<ref>Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. ''Psychoneuroendocrinology '' 1981; 6(3):269-75.</ref>
* Postoperative wound pain, in the case of children's circumcisions conceivably worsened by the forceful breaking of the preputial adhesions.
* Postoperative bleeding of the wound. This can have severe consequences especially for very young infants, if they are not treated promptly. Their blood volume is only about 85 ml per kilogram of body weight, and even moderate blood loss can lead to hypovolaemia, hypovolaemic shock and even death.<ref>Smart J, Nolan T. (Editors). ''Paediatric Handbook'', Sixth Edition. Victoria, Australia: Blackwell Science Asia, 2000: p. 82</ref><ref>Wetli CV. Case 93-1711. ''Autopsy of Demetrius Manker''. Miami: Dade County Medical Examiner Department, June 23, 1993.</ref><ref>Hiss J, Horowitz A, Kahana T. Fatal haemorrhage following male ritual circumcision. ''J Clin Forensic Med '' 2000;7:32-4.</ref><ref>Newell TEC. ''Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan''. Burnaby, B.C.: B.C. Coroner's Service, Monday, 19 January 2004</ref>* Postoperative infections. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.<ref>Dr.med Wolfram Hartmann, Stellungnahme zur Anhörung am 26. November 2012 im ''Rechtsausschuss des Bundestages''.</ref>
* Wound dehiscence, meaning the separation of the edges of the wound or the tissue after suturing.
* Adhesion between the surface or rim of the [[Glans penis|glans]] with the neighbouring penile skin, causing skin pockets and bridges, as well as visually unpleasant results like uneven scars, which make a re-circumcision necessary.
* Postoperative [[phimosis]]: a phimotic ring can develop during scarring, which makes a re-circumcision necessary. According to a study by Blalock et.al.<ref>Blalock HJ, Vemulakonda V, Ritchey ML, Ribbeck M. Outpatient management of [[phimosis]] Following newborn circumcision. ''J Urol '' 2003;169(6):2332-4.</ref>, the prevalence is 2.9%, according to Leitch<ref>Leitch IOW. Circumcision - a continuing enigma. ''Aust Paediatr J '' 1970;6:59-65.</ref> 5.5%.* Meatal stenosis, a pathological narrowing of the opening of the urethra, which mostly occurs in infancy and early childhood. It is one of the most common complications of infant circumcision. A study from 2006 found meatal stenosis exclusively in previously circumcised boys. The incidence rate after a circumcision is at approximately 10%.<ref>Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. ''Clin Pediatr '' (Phila). Jan-Feb 2006;45(1):49-54.</ref><ref>Stenram, A., Malmfors, G., & Okmian, L. (1986): Circumcision for [[phimosis]]: a follow-up study. ''Scandinavian journal of urology and nephrology'', 20(2), 89 PMID 3749823.</ref><ref>http://emedicine.medscape.com/article/1016016-overview</ref>
* Knot formation of the veins. If the dorsal vein, which originates in the tip of the [[foreskin]], is cut during circumcision without being clamped and sutured at its origin separately, it starts to develop new branches over time, which can lead to the development of knots.
* Possible deformities due to circumcision include hypoplasia of the [[penis]] (micro-penis) and induratio [[penis]] plastica (skewed penis).
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